25-35% of my patients on any given day were "sent in by their____(PMD, Urgent Care, Surgeon, Cardiologist). A few of these are legit but many are complete punts. I had a young patient with some vague chest tightness sent in from urgent care last week with an EKG that some PA had written "r/o ACS, inverted T waves in V1, with a helpful circle around the offending T wave".
Even better are the ones sent in by their PMD or past surgeon for evaluation of some problem who tell me "you must call Dr XXXX immediately, he is very concerned and wants to be kept in the loop". Of course when I call said Dr to discuss the patients and see what their expectations were they say "I have no idea, he/she is crazy, just admit them to the medical service to get worked up...or discharge them home....or do whatever you want, they're fine".
Not sure if this happens everywhere, I think in some places its an insurance thing, easier to bill from an admission through the ED...in others the MD doesn't want to deal with doing paperwork, orders, etc so they just scut out the ED...or even worse they don't want to expend the mental energy and would rather we make the diagnosis and admit for them to bill for the inpatient treatment. Either way I think there are a lot of ways we could cut these visits down