I recently had one patient complain about how their request for multiple referrals was handled so I thought it would be a good time to educate everyone about the process and the challenges a primary care provider faces in clinical practice. Because we are considered the "gatekeeper", which by definition is "a person or thing that controls access to something", we have the task and responsibility of submitting both appropriate as well as detailed referrals through the appropriate channels of the health care system. What surprises many is that it is not appropriate and quite disrespectful to their position to just call your doctor and say I need a referral to so and so and I need it now. A referral for many things require that the provider has actually examined the patient and have some clear written narrative that allows the accepting specialist to both triage and act on the request in an appropriate time period. The referral also has to be consistent with the patient's health insurance policies. Each and every referral I fill out requires administrative time and it is rarely something for which direct patient care of the day must be interrupted to address, unless it is an emergency. It is not unusual for me to be working on these at night. The fact that a patient showed up on their own to a specialist office and wants the request sent immediately is not a true emergency and circumvents the necessary visit with the primary care provider. The type of practice I have allows me the freedom to spend as much time as needed with a patient and I think most appreciate that. I think most also understand that beyond that time with them during the visit, I have a great deal of behind the scenes duties that require a significant amount of work. The maze of electronic paperwork required in this day and age given the complexity of government and insurance company involvement in the delivery of medical care is enormous. Yes, I have chosen to tackle all this myself, keeping my overhead low and allowing me a rare freedom most doctors do not have. Some days, I question whether it is worth it after submitting multiple referrals for a demanding patient that has no appreciation for what I do on their behalf. But, it is the other days, the days I hear back from appreciative and understanding patients that make it all worthwhile. If you are one of the latter, thank you!
Dr Leite-Evans and Dean Evans PA have both been in medical practice for over 30 years. Their clinical experience has ranged from pediatrics, to geriatrics, general medicine, psychiatry, preventive medicine and more.