Are Fears Of Losing Patients Preventing Appropriate Referrals?

Amanda Wright, Special Projects Editor

   “Having a professional relationship with a provider increases the chances that you will also receive a referral from the colleague of that provider,” notes Dr. Bell.

   David Armstrong, DPM, MD, PhD, has extensive experience referring out to other doctors, who refer back to him. This is a very common in his practice at the University of Arizona and was proven advantageous to him at a very young age through his father’s podiatry practice.

   “Having grown up with podiatry in my father’s office, I can tell you that I would routinely visit many doctors in our community around the holiday season, thanking them for referrals and they would thank my father in return. This was a mutually beneficial situation in an individual practice like my father’s and I can also tell you in a very large academic practice, it is essential for our future,” says Dr. Armstrong, a Professor of Surgery and the Director of the Southern Arizona Limb Salvage Alliance (SALSA) at the University of Arizona College of Medicine in Tucson, Az.

   “So many times people are sued not for what they did but for what they didn’t do. I think the more open you are in sharing your patients and getting the overall largess from the intellectual and diagnostic power in your community, the better off you’re going to be.”

   To be fair to colleagues and also show your gratitude when patients are referred to you, some physicians like to rotate referrals. In Dr. Bell’s practice, they commonly rotate referrals, especially when admitting hospitalists are involved. Spreading the referrals around to several different areas allows the referring physicians to form trusted relationships with multiple colleagues across all specialties and in several different practices or hospitals.

Emphasizing The Documentation Of Referrals

Impeccable record keeping can only help both the patient and the clinician. Documenting the condition and treatment of the patient in the podiatrist’s care, as well as the referral information, will keep the podiatrist protected. The referral information should include:

• Reason for a referral based on the initial assessment of the patient
• Referral doctor’s name, address and phone number
• Whether the patient was informed of the urgency in seeking further care

   It may be time-consuming to document every detail about a patient’s referral but in the long run, it will help the patient follow through with appropriate treatment and show that the physician was not neglectful.

   “We document if the patient has been informed of the need for urgency in seeking such referral and informing the patient of the potential sequela of failing to follow through with such referrals. A copy of the progress note is sent to the primary care provider (PCP), and with the permission of the patient, to the referral healthcare provider,” explains Dr. Jacobs.

   All of these protective measures ensure that the patient gets the urgent care needed. They also protect the referring physician by showing a proactive method for continued treatment.

   “The whole risk reduction principle hinges on documenting the referral, documenting that the consultation occurred and documenting the outcome. That means your office has to determine when the patient will be seen and that he or she was seen, and it is incumbent on you to get a report from the referral physician what the outcome was. These areas are serious weaknesses in failure to refer cases in which a patient in fact does not follow through and you did not know about it. Any plaintiff’s attorney can seize on that, making you look unconcerned, sloppy, et cetera,” says Dr. Markinson.

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