Comments on: A referral to a specialist turns patients into currency

By: Frank Drackman

Frank Drackman — Wed, 03 Jun 2009 17:17:36 +0000

Umm pickin a specialist isn’t THAT hard…and even if you are a mouth breather, the yellow pages makes it pretty easy, even putting “DIABETES” in parentheses next to “Endocrinologists”, and for the illiterate, theres a nice drawing of a “Heart” for “cardiology”…

By: Bruce Small

Bruce Small — Wed, 03 Jun 2009 15:01:28 +0000

“maybe yr pcp receives financial kickbacks from specialists for each referral he makes? Probably does. Wake up and smell the cof”

You made the illogical jump from maybe to probably in consecutive sentences, but without a shred of evidence and without knowing anyone involved. Arrogant is the word, apparently mixed with anger and envy. Bad combination.

By: family physician

family physician — Wed, 03 Jun 2009 13:42:27 +0000

Hey lotus: you smell the coffee. Nobody is getting kickbacks.

Hey specialist: what type of specialist are you?

By: A specialist

A specialist — Wed, 03 Jun 2009 12:34:11 +0000

I actually prefer that patients come to me without a primary care referral. Many referrals now are simply to cover the primary care’s a$$ and are a waste of my time and the patients time. As k mentions above, requiring initial evaluations by primary care often delays care and referrals are directed often for monetary reasons (you rub my back and I will rub yours) rather than for the benefit of the patient.

By: lottus

lottus — Wed, 03 Jun 2009 04:19:47 +0000

“Knowing what kind of specialist is usually the easy part. The advantage of going through my PCP is that he knows the really good ones, and which ones to avoid.”

maybe yr pcp receives financial kickbacks from specialists for each referral he makes?

Probably does. Wake up and smell the coffee/

By: ray

ray — Wed, 03 Jun 2009 02:58:42 +0000

For the really savvy patients it may be helpful to self refer but only a minority will benefit in this way and honestly which specialist will say – you really don’t need any further testing when patients are the money makers for them. Most insur still need PCP referrals. My uncle once self referred himself to cardiologist for what he thought was chest pain, got the whole nine yard work including angio ( My uncle was jogging 2 miles per day at that time) which was 100% clean. After a month of onging pain went to his PCP and it turned out he had a gall bladder infection which needed extensive complicated surgery since he waited too long. My Uncle said, ” The cardiologist looked me through a hole and didn’t see me as a whole.” If we give enough incentives and reward doctors to spend time with patients instead of chasing one test after another, we will all be at a better place. What incentive will a primary care doc have to spend an half hour with patient and make follow up phone calls? He will be penalised for his effort and labeled inefficent by the system.

By: AnnR

AnnR — Wed, 03 Jun 2009 02:02:28 +0000

My PCP knows all the easy tricks. There is no virtue in a fancy solution when a simple one will do.
My situation is made easier because my PCP has same-day scheduling.

By: Bruce Small

Bruce Small — Wed, 03 Jun 2009 01:27:49 +0000

Knowing what kind of specialist is usually the easy part. The advantage of going through my PCP is that he knows the really good ones, and which ones to avoid.

By: k

Wed, 03 Jun 2009 01:27:14 +0000

@Rishi -
Many insurance plans no longer require PCPs to act as gatekeepers. That was one of the driving forces away from the late 80s-early 90s highly restrictive HMOs toward PPOs.

Yes, some are sufficiently unaware of their medical conditions and therefore unable to choose the correct specialist. Others can’t choose specialists for financial reasons (e.g. Medicaid, uninsured).

If you’ve had a recurring issue or a particular condition for any length of time, it’s pretty easy to figure out what kind of “part doctor” you need to see without going through a PCP first. .

By: CIO

CIO — Tue, 02 Jun 2009 22:35:06 +0000

Another significant issue is that patients are being increasingly referred by PCPs for issues which do not seem to require specialty care. Subspecialty input in such cases is often superfluous or unnecessary and it is definitely more expensive to the patient and /or insurer. In the past, PCPs would have handled such cases by themselves however, (for a variety of reasons) they now refer such cases to a specialist.

The result is patient frustration, more expense (and I fear) less value. Specialists fees notwithstanding… Everyone loses.

Reference: http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all