Thursday, January 19, 2017

#10: Do You Even Need to See Me?

Dear Dr. Tumoriffic,

Why do I need to have an appointment with my PCP to get a referral to see a specialist? If I have a skin condition, for example, why do I need to go through the time and trouble of an appointment with my doctor BEFORE I can go see a dermatologist?


Dear Ruprect,

You have to see your PCP because your PCP is needy. Be kind to your PCP. Clearly, he or she is just insecure and wants to be loved. Bring them candy, and they'll refer you to a special specialist.


The reasons I often bring in patients before I refer them out (or order testing) are:

1.  Often, I can diagnose and treat you myself, and I can almost always see you more quickly than a specialist can. That nasty rash you have between your legs is just jock itch. I can fix it with a good, strong antifungal cream.

2. In addition, if I cannot treat you, the information I get from seeing you gives me the ammunition I need to call the specialist and get you seen immediately instead of waiting for weeks the way you normally would. *

3. Also, you might be asking for the wrong specialist, and I may need to see you to pick the right one. For instance, your rash may be caused by Lyme disease, in which case, you don't need a specialist, you need a doxycycline prescription. Or, "why no, Mr. Smithers. That's not where your pancreas is. You actually need to see a urologist."

4. My healthcare organization does not get paid when I don't see patients. I am not like a lawyer who bills by the hour. Although I will refer a patient directly to a specialist if I am absolutely sure they won't benefit from seeing me, when I do that, the time I spend making the referral (which involves some thinking and writing) comes out of my own free time. Not all doctors have the time to do that, and some organizations may actively discourage it.

This last part is a shame. In a sane world, there would be an incentive for doctors to get their patients wherever they need to go as efficiently as possible. But our system is not based on efficient patient care. It is based on efficient money-harvesting from insurance companies.

Be well,

Dr. Tumoriffic

* For example, at my job, I can take a photo of your rash with my iPhone and get an electronic dermatology consult. The dermatologist looks at the picture and, if they can make the diagnosis based on the photo and my description of what is going on, they can treat you without bringing you in, or they can get you a faster appointment.

The Dog will see you now.

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