Referral – What a PCP and Patient need to know!

Communication is a critical aspect of healthcare. Most healthcare providers across the country have systems, processes, and procedures implemented to ensure smooth flow of communication. However, such innovations are largely focused on improving in-facility communication, resulting in poor communication between facilities.

The ability to send and receive information between facilities can not only improve the patient healthcare outcome but also enhance healthcare efficiency. A referral management software would simplify procedures between primary care physicians and patients. It would also help PCPs to closely monitor the progress or the outcome of the patients who are referred to a specialist.

Problems With Conventional Referrals:

  1. Physician refer patients but cannot follow up
  2. Lack of communication between primary physicians and patients
  3. Patients not meeting the referred specialist
  4. It is impossible to send follow-up information

The existing problems listed above highlight the Complexity in current referral procedures. The root of these issues can be traced to the physician’s practice because they are the ones who initiate a referral.

Here are some key points that PCPs are expected to validate before sending out a referral to a specialist.

Get to Know Your Patients More

Knowing a patient is as important as knowing about the problems they have. The patient outcome should be foreseen before a referral is made. Most patients visit one PCP whom they trust to a great extent. If the referral process does not meet their expectations, the patients may seek alternative options.

In some cases, patients get the second opinion from another physician after getting suggestions from a specialist. This scenario happens quite often despite being a reverse process. This shows the importance of PCP in the referral cycle as it is their responsibility to ensure patients’ smooth transition and get the required care.

Do Patients Really Need Specialists?

Once a patient selects their PCP, they generally don’t see any other physician or specialist unless a need arises. Here PCPs are the generalists who take full responsibility for their patient. Before getting a patient to step into the specialist’s office they must identify a clear need for the specialist’s visit.

Also, general practitioners could solve many of the patient’s problems without the need for a specialist’s help. Only in some cases do physicians require additional visits to identify the problem. If after multiple visits they cannot diagnose the problem they will send patients to a specialist at the time of need as they are primarily liable for their patient’s care.

Managing the Referral

To avoid any delay in patient diagnosis, some physicians make referrals frequently. But referring more does not mean it is the optimal approach.

Most referrals happen within the network. Physicians send patients to specialists who are known to them and these specialists can easily follow up to them, which helps in closing the referral loop. When this process does not go as planned then the PCP will stop referring to that particular specialist as referral closure is important to identify the patient’s health status.

Key points a patient must be aware of:

  1. Referral is an important process in healthcare
  2. Referral success partially depends on patient cooperation
  3. The referral will require some patient-related data transfer and some methods of data transfer are safer than others.