Why patients get unnecessary referrals to consultants

Recently, a physician colleague asked me a question about a patient. The patient, who had already been seen by another allergist, was referred to another physician (“the consultant”) for evaluation. The consultant was in the same healthcare system as my colleague, but the allergist was not. In evaluating the patient, a specific allergy question came up.

The consultant asks my colleague about this question. What was interesting was that the consultant admits the patient already has an allergist but did not appear to make an attempt to discuss the case with the “outside” allergist. The consultant wanted the health system allergist to see the patient.

Now, there are alot of unknowns in this case. But what is very concerning is that the consultant seemed to completely discredit the role of the outside physician. The outside physician could have very easily and quickly answered the question that was posed.

Instead, the patient will now probably have to see another physician at the healthcare system at significant cost. Does not seem to me that this was the most judicious use of dollars.

As physicians, we can all relate to this scenario. Undoubtedly, we all have anecdotes that we can share that are similar. What is more concerning is the anecdotes that we don’t know about — those patients who are referred to another physician by a colleague and are left with the impression that you did not know what you were doing.

All of us can relate to the patients we send to the large medical-industry referral center to never see the patient again.

It makes me wonder, with the advent of local or regional medical-industry complexes, how much savings will be done? If a patient has the “nerve” to see physicians who are in different medical systems, how much care will be repeated? How much information will be shared? We have reached our benchmarks for this patient and this disease so we are not sharing the information? How much do the physician corporate medicine executives really care about patient care? Or do they really care more about the system and the bottom line?

Time will tell with all these changes. But one thing is certain, patients will be the guinea pigs and they won’t even know it.

Andrew Murphy is a physician. 

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  • http://twitter.com/2healthguru Gregg Masters

    Wouldn’t HIEs & community based EHRs mitigate the internal system bias?

    • http://twitter.com/DarrellWhite Darrell White

      Yes and no. The Consultant would have had to look, could have ignored the outside Allergist’s note/conclusion as easily as not picking up the phone to call, effectively diminishing the outside Allergist in the patient’s eyes in the same way for the same purpose. 

  • http://twitter.com/DarrellWhite Darrell White

    Institution before physician before staff before payer before patient. Welcome to the business plan for the ACO. 

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