Viewpoint
From The Chief Medical Editor

The Reality of Referrals

Larry E. Patterson, MD

One of the advantages of working with optometrists is that I get easy access to their magazines and literature. And while we ophthalmologists might not agree with everything optometrists print, there are still some pearls that can be gleaned from their literature. My favorites are those involving humor.

There's a really funny optometrist, Montgomery Vickers, who once penned an article detailing many facts that all eye doctors can attest to. He noted, for example, "If you order a custom-made toric multifocal soft contact lens for trial fitting purposes, the patient will tear it the first time he tries to insert it." Or, "The more kids in one family you schedule on the same day, the less chance they'll show up." And, "If a patient calls you complaining of sudden vision loss, it will be on a Sunday afternoon, even though he first noticed it on Tuesday."

These things are funny, because in some form or another, we've all experienced similar patient encounters in our own practices.

Unfortunately, this one really got my attention: "If you refer a patient to a general ophthalmologist and he refers for consultation to another ophthalmologist, you will never see this patient again."

OK, maybe not in 100% of cases, but you know in your heart he's probably right quite often on this one. It's easy to do. You're not trying on purpose to snub the referring OD, but he or she has sent you this patient who has bullous keratopathy, and you promptly refer the patient on to the corneal specialist for transplant surgery. (Due to the recent loss of consultation code reimbursement, I'm just happy I can "refer" again and not worry about "consulting" any more.) And you even write a nice letter to the optometrist explaining your findings and course of action.

What you forgot to do, of course, is inform the corneal specialist that you are not the patient's primary eye care doctor, and that you'll both be needing reports sent. You get a letter, and forget to send a copy to the optometrist. Neglect is felt, and you never get a referral from that person again.

I know this happens, because the shoe recently was on the other foot. I had a patient who needed a retinal specialist's advice, and during their exam they also noticed some band keratopathy. I had seen it as well, but had wanted to wait until I got the retinal problem resolved. So what did the retina practice do? They referred him on to a corneal specialist for treatment.

But I only found out about all this many months later during a follow up exam with the patient. My patient. I never received a letter from anyone about any of this. I felt violated. And in conversation with the patient, he was quite surprised to learn that I had not been kept abreast of any of this.

Lessons learned? In all our dealings with patients, be clear as to who the primary eye doctor is, and keep them informed of all significant happenings with their patient. Whether optometrist, general ophthalmologist or specialist, we all need to work together for the common good of our patients.