According to a report in the Annals of Family Medicine, 45 percent of physicians receive new patients through doctor referrals yearly. And although independent physicians aim for high patient retention, referrals can sometimes be ideal — or even necessary — to smoothen the overall patient experience and reduce care gaps.
How do doctors know when it is best to refer a patient? Read on for a few considerations for medical referrals.
Times doctor should consider a patient referral
1. When they struggle to make a diagnosis
There will be times when, no matter how hard you try, you just won’t be able to determine how to best help a patient. Don’t stress, because there are other doctors out there that can help. This isn’t defeat, it is a mutual goal to diagnose a patient in the most efficient way. Consider referring your patient if you find yourself in this situation.
2. When they want a specialist's opinion
They say two heads can be better than one. Sometimes, you might need to refer to a specialist. Specialists often can have a different opinion that might benefit the patient.
According to the Archives of Internal Medicine, about one in 10 visits to a primary care doctor resulted in a referral to a specialist in 2009. If you see that your patient has risk factors, or if you simply want a second opinion, a referral to a specialist might be the way to go. Specialist referrals don’t necessarily hurt your patient retention, because you are still involved in the patient’s journey.
3. 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 reasons, but you should always first try to work through any problems in order to deliver care to the best of your ability.
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 vibe with. Refers like this could be mutually appreciated.
4. When they want to improve patient access
According to the Journal of General Internal Medicine, 27.9 percent of doctors end up referring their patients because of patient access concerns. Patient access includes convenience of location, availability of appointments, and the language the doctor speaks.
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, doctor referrals 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 to discuss the referral. 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, restricts the initial visit to the specialist (rather than a physician’s assistant or nurse practitioner), 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 referral 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 from physicians you refer to, 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.
- Though 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.
Although it might be a tough goodbye to offer a referral, sometimes it’s the best solution. Patient satisfaction could increase, and your practice might see more referrals from current patients who are more satisfied with their overall care.
For more tips on how to improve the patient experience, check out our three part series on the topic. Start with “Part 1: pre-visit.”