Are Fears Of Losing Patients Preventing Appropriate Referrals?

Amanda Wright, Special Projects Editor

While a variety of issues may contribute to a reluctance to refer patients for some physicians, ensuring appropriate and timely referrals can facilitate optimal patient care and go a long way toward preventing potential malpractice lawsuits.

Strong professional bonds with loyal patients are not uncommon for many clinicians but sometimes even with the best intentions to treat every patient, it is just not possible. What happens when you need to refer to another doctor due to a complicated diagnosis? While you may have a database of trusted colleagues to whom you refer, is there also some anxiety that you may lose a patient to a referred physician? Alternatively, a lack of a timely referral could also result in a malpractice case, costing the physician time, money and potential damage to a good reputation. After interviewing several podiatrists, it is clear there are mixed feelings on this controversial topic.

   “My personal opinion is that it is human nature to be paranoid about losing patients to a competitor’s podiatry practice,” says William Fishco, DPM, who is in private practice in Phoenix. “Firstly, we are podiatrists and secondly, we are businessmen and women who want to protect our practices.”

   While some physicians completely understand the fear of losing patients or diminishing business in one’s practice, others simply find that those who fear such loss need to form more trustworthy relationships.

   “In my opinion, (a practitioner who fears the loss of a patient) probably has developed poor collegial relationships or very few relationships. This coupled with any insecurity issues would make that doctor reluctant to refer,” adds Bryan Markinson, DPM, an Assistant Professor of Orthopaedics and Pathology at the Mount Sinai School of Medicine in New York.

Why Would There Be A Reluctance To Refer?

Understandably, podiatrists want to protect their practices as there are some cases in which doctors do lose patients or experience severe miscommunication when treating a patient, which can quickly sever a relationship.

   Desmond Bell, DPM, shared a story about referring to a vascular surgeon after detecting progression of a patient’s peripheral arterial disease. The patient had ulcers on her feet and legs, due in part to paraplegic status. After the initial assessment, Dr. Bell suspected that a bypass was necessary. The patient complied and went to get the opinion of the vascular surgeon. She returned to Dr. Bell several months after the next scheduled appointment, having had a below-the-knee amputation unbeknownst to Dr. Bell. The vascular surgeon also continued wound care on the remaining lower extremity without any communication with Dr. Bell. While the patient did return, Dr. Bell notes that any further care on the remaining limb should have been with him as he was the original physician. As a courtesy, the vascular surgeon could have at least noted the need for amputation rather than a bypass.

   “Poor communication can cause many problems that could easily be prevented. A two-minute courtesy call can build trust and goodwill, and is a great marketing tool as well,” explains Dr. Bell, Co-Founder and Executive Director of the Save a Leg, Save a Life Foundation.

   Aside from losing patients, there may be other contributing factors to a podiatrist’s reluctance, including an element of defeat due to the inability to treat the patient.
“Reluctance to refer a patient to another podiatrist may be in part fear of criticism of care, loss of the patient and the income that comes along with it, and finally, the feeling of failure in that he or she could not provide the service that was needed,” notes Dr. Fishco, a faculty member of the Podiatry Institute.

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