The Folly of Self-Referral

Check this out. What you will see is an interesting little riff by The Country Doctor on the topic of self-referral. In it, he points out that many people, including yours truly, tend to favor a system that allows patients to make their own appointments with specialists without going through a primary care physician for a referral. My penchant for avoiding being “gate kept” has always been a major reason why I avoid anything that looks like an HMO like the plague. BUT. He goes on to make a reasonable point, questioning whether patients have the ability to figure out which specialty they should be consulting, let alone which subspecialist might be best for a particular problem. Where do you go for chronic pain in the stomach? Surgeon? Gastroenterologist? Psychiatrist?

I think he has a point. While still not being too keen on the idea of having to be clutching a referral slip when I enter a specialist’s office, I greatly value the ability of my concierge Internist to direct me to the right place. She not only sorts out for my wife and I the appropriate specialty to consult, but also which specific doctor in that specialty would be best suited for our presenting medical issue. Example. Our physician diagnosed my wife several years ago as having thyroid cancer. Living on Hilton Head Island, SC, with a “medical community” ranging from our little island to Savannah to the South and Charleston to the North (including Medical University of South Carolina, with its thousands of doctors), who should she go see? Based on her experience and expertise, our doctor sent us to Dr. Denise Caneiro-Pla at MUSC. She just happens to be flat out the best Endocrine Surgeon (I never even knew there was such a thing!) south of the Mason-Dixon Line. Probably in the U.S. The outcome? Excellent medical care and a cure, thanks to Denise.

Bottom Line. I think that this issue needs some reconsideration and repositioning. While I still object to being subjected to patent cost saving moves by HMO’s requiring of a referral for a specialty consultation, especially for “out of network” care, I have very much come to value my Internist’s guidance on the matter. It would indeed be “folly” for me to sidestep this expertise.

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