Off the Cuff: Our Intermediary Role When Referring

Last month my associate told me about a situation that was happening with his 85-year-old grandmother who lives in Florida. She was having symptoms of flashes and floaters and saw her optometrist. The optometrist told her she may have a retinal tear, and she needs to see a retinal specialist… and that was it. His grandmother, who speaks English as a second language, was expected to understand the diagnosis and find her own retina specialist. Her optometrist didn’t give her any names, didn’t schedule her an appointment, and didn’t even relay to her the potential urgency of what was going on with her eye. Thankfully in this situation, her son-in-law (New York) and grandson (Arizona) are both in eye care, knew practitioners in Florida and were able to scramble to get her an appointment. Fortunately, it ended up being a posterior vitreous detachment, but this was a perfect scenario that could have ended horribly for patient and practitioner.

When recommending that our patients see another practitioner, we are the ones our patients know and trust. Who we recommend is a much bigger deal than just finding some random name for them to see. The doctors we refer to become an extension of the care we provide. The list of providers you refer to should be consistently evaluated and modified. After the initial hurdle of “do they accept the patient’s insurance” is cleared, things I consider regularly on whether or not I continue to refer to someone include: do I get consistent excellent patient outcomes from this provider, do they communicate every time the patient is seen and what the care plan is, do they refer the patient back after their role is done or do they try to keep the patient, and what do the patients think of their experience with that office’s staff, the doctor, and the office as a whole. I’ve had patients tell me about downright rude staff members, doctors being dismissive and barely talking to the patient, and being hard sold procedures and lens upgrade options at the office and one more last-ditch effort at the surgery center. This is the classic scenario of would you want your mom/dad/partner/sibling to experience this office based on what you know? Obviously, there’s times it’s just a one-off personality clash or someone was having a bad day, but when you hear the same complaint from more than one source or have the same concern repeatedly, it’s time to cut ties.

Our role when referring a patient has to be one of communication intermediary. We need to communicate with the patient why they’re being referred, communicate who we are referring to and why they’re the practitioner you’re recommending, communicate what’s likely to happen, communicate the level of urgency, and communicate when we plan on seeing them back. In my practice we set up the appointment for the patient before they leave the office and give them everything we send to the referral doctor so they can hand carry it as well. It’s not uncommon to have a patient call and need an interpretation of what they were told at their appointment, so not receiving clear communication back should be considered a dealbreaker. The role of clear consistent communication with the referral doctor, the patient, and frankly, in all relationships, is key to positive outcomes, longevity, and trustworthiness. Anything else is a setup for potential failure for your patient, your practice, and everyone involved.

Shannon L. Steinh?user, OD, MS, FAAO - Chief Medical Editor

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