Not Your Father’s Referral

In the good old days we expected a physician to refer to the colleague they believed would provide the best care for the patient. No more. Now so many other factors, many of which the referring physician may not know about, come into play that the patient might do as well or better on their own:

  • Payer: Does the physician treat patients with Medicaid or Medicare?

  • Payer: Does the physician contract with or accept assignment from the patient’s payer?

  • Does the physician accept cash payment?

  • Can the patient afford the physician's fees?

  • Does the physician work for an HMO or the same system?

  • Is the physician’s office location accessible to the patient?

  • Are the physician’s office days and hours convenient for the patient’s schedule?

  • Does the physician require drug testing? How often?

  • Does the physician require “pill counts? How often?

  • Does the physician offer videoconference encounters?

  • Does the physician insist that everyone gets psychotherapy regardless of whether it is indicated?

  • How much time does the physician spend with the patient?

  • Do the physician’s philosophies and approaches to the problem work for the patient?

  • Does the physician belong to a hospital medical staff?

  • Does the physician provide foreign or sign language interpreters?

  • What is the physician’s religion, sexual orientation?

  • Does the physician communicate with patients via email, text, paper, phone?

  • Will the physician’s other office policies be acceptable to the patient?

I believe the old notion that holds a physician responsible for referral has gone the way of the horse and buggy.


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