Are Fears Of Losing Patients Preventing Appropriate Referrals?

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Amanda Wright, Special Projects Editor

   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.

Malpractice: What Could The Fear Of Referral Ultimately Cost?

Though fear of losing business, failing to treat the patient or criticism from peers may be motivating factors to avoid referrals, there is one very important reason to refer patients — malpractice.

   One of the worst scenarios for any physician is a malpractice lawsuit. Lack of a timely referral truly isn’t worth the risk of a lengthy, costly court battle.

   “It is an ever present fact that in all risk management courses, podiatrists are encouraged to refer to reduce the chance of allegations of malpractice,” says Dr. Markinson.

   In the August 2007 issue of Podiatry Today, an article (“Seven Keys To Preventing Malpractice Lawsuits”) included a case in which the jury awarded a patient $1.23 million because a podiatrist failed to refer him to a vascular surgeon in a timely manner. He went to the podiatrist for severe vascular insufficiency and ischemic foot ulceration. He received antibiotics and the podiatrist scheduled him for a return visit two weeks later. At the next visit, the podiatrist referred the patient to a vascular surgeon for consultation 17 days later. The patient went to a local emergency room with a necrotic foot before seeing the vascular specialist. After subsequently undergoing a below-the-knee amputation, he filed a lawsuit against the podiatrist and won.

   “(Given that) medical malpractice actions are founded upon real or perceived poor results, the failure to refer implies or suggests that the adverse outcome from treatment could have been averted with timely referral,” explains Allen Jacobs, DPM, FACFAS, who is in private practice in St. Louis. “Anyone with experience in the review of such matters will confirm that not infrequently, the subsequent treating physician, particularly when he or she is an orthopedic surgeon, will suggest either overtly or in a sub rosa manner that the previous treating doctor was negligent.”

Key Advantages Of Referring

To avoid malpractice and provide the best possible patient care, it is important for podiatrists and doctors in all specialties to form relationships within a network of trusted colleagues. Working within a team and utilizing network referrals can truly expedite patient care.
“From a medical/legal standpoint, it makes sense to refer to specialists rather than hold on to the medical ‘hot potato,’” says Dr. Bell.

   If something goes wrong for any reason and you knowingly did not refer the patient in a case in which you could not adequately treat him or her, you open yourself up to a plethora of legal battles.

   “My advice to those who are reluctant to refer is stick to what you do best. Even though you would like to handle everything for your patient, refer anything and everything out that you are not comfortable handling. My residency director always used to say, ‘you don’t want to be the only one carrying the coffin,’” says Dr. Fishco. “I refer out on a regular basis. For example, I have never mastered arthroscopy. When I have a patient whom I feel would be better served with arthroscopy rather than an open procedure that I am comfortable doing, I refer him or her to my DPM colleagues who can do a good job for the patient.”

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