Wednesday, October 06, 2010

The Etiquettes of Making a Referral

I won't claim to be an expert in how one should order a consult for a patient. But speaking as someone on the receiving end, I've learnt that there are some things that make a consult more challenging. And so, if there is something I could ask for when physicians send me their patients, they would be:
  • Be specific. Are you sending the patient to me for hyperthyroidism? Osteoporosis? Don't just put on the consult request: 'Thyroid issue' or 'Hormonal imbalance'
  • Along the same lines, don't add a list of issues just because the patient is coming my way. Because we have limited time for the patient, it helps for me to know what exactly you want me to address. Don't send the patient here for 'Diabetes/hyperlipidemia/hypothyroidism/weight gain'
  • SEND your clinical notes or lab results. If you send nothing, I'm often forced to do my own set of labs. If this has already been done, this is a redundant cost to the patient. Also, it's only polite to send your notes over before I see the patient. It helps no one for me to see a patient and to have absolutely no idea why they're here
  • Don't promise the patient anything I can't deliver. The ones I know I disappoint are the patients who are sent my way for 'Weight Gain' or 'Fatigue' and have been told by their physicians that the 'endocrinologist will be able to help you...'. Unless there clearly is an endocrine issue, I'm not sure I can live up to those promises
  • I'm a subspecialist. I don't practice general medicine anymore. So, just because I've seen your patient doesn't mean that I'll be taking over his opioid medication management, or prostate meds
  • Check before you send the patient over, if we're 'in-network' for the patient's insurance. Though it may be revenue for me, I really hate it when patients end up paying a lot out of pocket. I'm not here to make their lives more difficult for them