Inclusion of Clinical Photographs with General Dental Practitioner Electronic Referrals of Patients with Oral Mucosal Disease to Secondary Care – A Service Review

Abstract Introduction This study looks at how the inclusion of photographs in referrals to an oral medicine specialist service can improve the adequacy of the referral for triage, prioritisation, and diagnosis. Materials and Methods Data was prospectively collected from e-referrals over a 4 month period. We recorded any change in appointment prioritisation at the vetting stage, and the inclusion of photographs. Results Only 29.5% of referrals included a photograph. 5% were rejected with advice, as it was clear from the photograph that the patient did not require a secondary care appointment. 14% of all referrals were upgraded in urgency, five of which were due to concerns of malignancy. Of these, 80% included photographs, and 3 were upgraded solely based on these photographs as they showed features of possible malignancy, where the written element of the referral did not describe nor raise such concerns. Discussion and Conclusions Including a photograph with a referral can often make up for inaccurate or insufficient written content, allowing appropriate and safe prioritisation, especially where the referrer has failed to recognise possible malignancy. Photographs can also prevent unnecessary referral upgrades, ensure an appointment is necessary and can be invaluable as a baseline comparator.