Why are so many patients referred to specialists?

Do generalist doctors refer to specialists too much?

Jeffrey Parks, otherwise known as the Buckeye Surgeon, has written numerous times on the issue, and his feeling is, yes, they do.

And he’s right. There are many physicians, along with mid-level providers like nurse practitioners and physician assistants, that refer to a spectrum specialists for routine conditions, especially in the hospital setting.

Dr. Parks asks, “shall we continue with the status quo of unabated mass-consults where a patient gets admitted to an internist’s service and ends up with consults from surgery, GI, ID, and renal; all for a demented little nursing home lady?”

No, we shouldn’t.

The fee-for-service payment system has something to do with the behavior, compounded with the tendency to practice defensive medicine. As long as generalist doctors continue to get sued for not consulting fast enough, the incentive will always be there to reflexively refer.

And in the outpatient setting, so long as time is not valued, some would rather send the patients off to a consultant, rather than spend the time necessary to diagnose a problem.

We know that more doctors involved in a patient’s care doesn’t necessarily improve his health. Fundamental changes in both the payment and malpractice system is the only way I know to resolve this.

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