Dr. Leverton, former medical director of Kaiser Permanente in Oakland, Calif., uses the story to illustrate the problems that plague the referral process. From basic communications problems to the more delicate issue of who manages patients after a trip to the consultant, the referral process is often a balancing act for primary care physicians and specialists alike. A major part of the problem has to do with expectations that are never met.
Consultants receiving referrals expect patients to arrive with chart notes and test data.
In turn, the referring physician expects the consultant to offer an opinion promptly, in writing or otherwise. Managed care can add more problems. Physicians must often refer patients to consultants listed in a managed care directory whom they don't know or whose judgment they may not trust. Consulting physicians must resort to guesswork when referred patients arrive without test results or any notes from the referring physician. It's particularly problematic with older patients who have multiple medical problems.