Referring a patient to another provider is a common practice that helps ensure patients receive the care they need. Referrals can sometimes be ideal — or even necessary — to smooth out the overall patient experience and reduce care gaps.
A doctor might choose to refer patients for a variety of reasons. How do doctors know when it is best to refer a patient? Read on for a few considerations.
When doctors should consider a patient referral
1. When they struggle to make a diagnosis
There will be times when you won’t be able to determine how to best help a patient. Don’t stress because there are other physicians out there that can help. This allows the patient to get the answers they desire in the most efficient way. Consider referring your patient if you find yourself in this situation.
If you are the patient’s primary care physician, enhance communication with the other provider, so you may follow up with your patient once they receive a diagnosis. Depending on the circumstance, you will remain part of your patients’ long term care plan. Keeping open dialogue with your patient and the doctor you referred them to enhances care outcomes and patient satisfaction.
2. When they want a specialist's opinion
A specialist has additional expertise in the branch of medicine they specialized in, and some doctors even further specialize in specific conditions or types of treatments. Doctors often will refer patients to a specialist when they’ve made a diagnosis that requires specialized care or to help determine a diagnosis. Sometimes a specialist can have a different opinion that might benefit the patient.
If you see that your patient has risk factors, or if you simply want a second opinion to confirm the best course of action, a referral to a specialist might be the way to go. This also won’t hurt your patient retention because you are still involved in the patient’s journey.
3. When their patients want a second opinion
Sometimes patients will specifically request a second opinion from another physician. According to a recent patient survey, 75 percent of patients report going online to search for a doctor, dentist, or medical condition. The majority of patients are involved in their own care and try their best to understand their options. Some patients need more time or help in navigating difficult healthcare decisions.
Thus, your patients may simply seek a second opinion to help confirm your thoughts or get another option that is right for them.
4. When they know a patient will click better with a fellow physician
Every doctor comes across a patient they don’t see eye-to-eye with every once in a while. You might not gel with certain patients for a variety of reasons, but you should always first try to work through any problems in order to deliver care to the best of your ability.
In a survey, patients said they value a provider who is a good listener above other factors (besides quality care). So if you’re not getting along with your patient, that may also impact your patient satisfaction scores. It may also impact your online reputation if a dissatisfied patient decides to leave a public review.
If nothing is working — if you just can’t get through to them — it might be time to refer the patient to a colleague you think they will better get along with.
5. When they want to improve patient access
Patient access includes convenience of location, availability of appointments, and the language the doctor speaks. This directly impacts a patient’s ability to get the care they need.
If you find yourself in a situation where it is difficult to communicate with your patient, or you are overbooked and can’t see them in a timely manner, a referral could be the solution.
How doctors can best refer patients
After deciding to refer, use a protocol or a referral management software program that is followed by all practitioners in the office. Here are some helpful guidelines for referrals:
- Determine and document the reason for the referral in the patient’s medical record.
- Before contacting the other physician, explain to the patient why a referral is necessary, including what the patient should expect from their visit with the specialist. Allow time for questions, and encourage the patient to ask questions during the referral appointment. Document that the patient has been informed.
- If the referral is critical, the office staff should make an appointment before the patient leaves. The patient should be given the information about the specialist, including the address and directions.
- Contact the specialist directly. Provide information on the patient’s current situation, as well as other medical records, test results, and documents to avoid duplicate effort.
- Agree on the urgency of the referral, how long the process might take, how often to communicate, and who will manage the patient during the referral timeframe.
- A referral agreement that defines roles and determines who will deliver final medical advice to the patient can eliminate confusion between physicians and their staff. Add deadlines for the initial referral visit and the consult report.
- Create a method for monitoring report due dates, so that reminders can be sent. This also documents that the patient is being followed during the referral period. Conduct quarterly audits to determine if there are specific physicians who are not timely. If you find a physician is inexpedient, consider referring future patients to a different specialist.
- When consult reports arrive, review the results and recommendations. There is a liability in failing to read and/or act on a specialist’s evaluation. Contact the specialist with questions about the patient’s specific diagnoses or needs.
- If the most appropriate referral is outside the patient’s insurance network, appeal the restriction on the patient’s behalf.
- Although a referral is an important part of patient care, patients are not obligated to follow up with the specialist. If the referral isn’t completed, talk to the patient during the next visit to find out why, and document the response. This “closes” the case, although the patient can still be encouraged to see a specialist.
Enhancing communication for better care outcomes
What happens when a doctor refers a patient to another? Ideally it would result in what is called “a closed referral loop,” in which the referral appointment is completed and results are then shared with the patient’s primary care physician or the referring physician. But in a study by Duke University, only about 34.8 percent of referral scheduling attempts analyzed resulted in documented complete appointments. Maintain open communication between you, the patient, and physician you’re referring to so that the patient is able to complete their appointment.
The same Duke University study found that common reasons for failed scheduling attempts include a lack of appointment dates and significant differences in wait times and distances to specialists. When choosing a physician to refer to, try to emphasize convenience and facilitate access for the patient. They will appreciate it, and they’ll be able to better access the care they need.