Diagnostic Referral is, Basically, a Failure...

[Old_Mil]

There's something I've come to realize about medicine as I've moved through the training process and watched primary care physicians practice...

..this is the difference between a diagnostic and a therapeutic referral.

Certainly, the latter is a legitimate use of the referral system. By all means send the patient in kidney failure to the nephrologist for dialysis, or the patient with known cancer to an oncologist for chemo.

However, far too often I see PCPs "punt." Something that is not a spot diagnosis gets referred out without any further workup, without any labs, without a diagnosis...and with only a vague idea of where it should be referred. Hence patients that rightly should be in Neuro clinic end up in Rheum clinic, and vice versa.

I'm painting with a broad brush here, as there certainly are PCPs who don't take this approach.

But my ideal world would be one in which primary care knew 75% of everything the specialists did and referred people on with imaging studies, labs, and the diagnostic work complete in far more cases than I see today.

Your thoughts?

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[lowbudget]

Is it failure? Or knowing one's limitation?

Common malpractice claims on PCPs are failure to diagnose & failure to refer in a timely manner.

 

[J-Rad]

As someone who trained in a primary specialty (peds) and is now training as a sub, I agree that this can be a fine line to tread, especially, as LB referenced, in today's litigious environment. I'll bet many, to most PCPs do a good job balancing the "referral point" (for lack of a better phrase) not referring too early or too late, though there may be a pressure toward the former. Anyone who is willing to maintain a good and up to date fund of knowledge (admittedly difficult for all primary care fields) will probably find this referral point well. I think one of the important things to keep in mind for referrals is to have a clinical question in mind and put it in the referral. A vague (or even empty) referral with no real indication for the person showing up in the sub's office is painful for everyone. As far as labs, a PCP can send off those labs that they routinely send or that aren't in the realm of esoterica that would help form the clinical question, and then make the referral.