Referrals in the medical field ensure a patient receives care from a physician with specialized expertise. Millions of referrals to specialists occur yearly.
Unfortunately, some primary care providers (PCPs) fail to refer patients after determining that a patient’s condition is outside their scope of expertise, requires specialized knowledge, needs advanced procedures/equipment or does not improve with primary care treatment.
Physicians have a fiduciary obligation to refer patients to other professionals in a timely manner when doing so is in the patients’ best interests and welfare. So, why does failure to refer happen?
Diagnostic misjudgement
When there is a fault in the initial diagnosis, for instance, a condition is incorrectly identified (misdiagnosis), a healthcare provider may not recognize that the underlying condition falls outside their specialized knowledge. The doctor may only order tests that confirm their initial diagnosis and not consider alternative diagnoses that would require specialized expertise.
Overconfidence
Some physicians are overconfident in their own clinical judgment. They may believe that they can manage a condition outside their skills without the knowledge of a specialist. This can happen because they overestimate their expertise or underestimate a patient’s condition.
Financial motivations
Failure to refer sometimes stems from financial motivations – a physician does not want to lose a patient. Some healthcare settings even have compensation models that penalize doctors for sending revenue out of their system.
Conscientious refusals
In certain scenarios, PCPs have been reported to refuse to refer a patient to a specialist for a procedure that conflicts with their deeply held moral, ethical or religious beliefs. While the American Medical Association (AMA) allows physicians to exercise moral integrity, it should be balanced with their duty to patient care.
Failure to refer can lead to the worsening of a condition or death. If you or your loved one sustained harm because of such negligence, learn more to know the steps to take.