Referring Out: One of the Pit Falls

When you are in Private Practice, most of the time you are not associated with an ENT, although I do know of a couple of independent practitioners who do have this particular set up and have a good relationship with the physicians. I do not have the numbers in front of me, but I would venture to say most of us have to refer out when we find a medical contradiction. What do we do when they do not come back to us, or find out that office tries to “keep” them.

I have this situation quite often in the city I live in. I know we are not as cut-throat as other cities in my state, but it seems to be getting worse. There is one ENT in town that I respect very much and he placed my youngest son’s PE tubes when he was 18 months. I usually send my patients to him. The problem is he is so popular that it sometimes takes 2 to 3 months to get into see him. So, the ENT office will offer another physician to have the patient in immediately, which is better for the patient. One of our patients came back very upset because the ENT office tried to sell her hearing aids while she was there. This started a landslide of communication between her, the ENT office and ourselves.

Since I have an unwritten rule to wait three days to send a letter out (I tend to write emotionally and can take multiple drafts to get it out of my system), I eventually sent a letter. Of course the names and a bit of the content have been changed.

February 13, 2011

To all of All American ENT (AAENT),

I would like to make sure that we are all on the same page when I send patients to All American Ear Nose and Throat. I am bound ethically and medically to refer people we know can be helped due to a middle ear issue or to follow up with retrocochlear possibilities.

I have specifically referred to “Dr. Brown” in the past because my patients come back to me and state how respectful and knowledgeable he is. Due to this popularity his schedule is very booked. When our patients call for an appointment another ENT is seen so the patients do not have to wait as long. This is wonderful for the patient.

My concern is, and I am not sure if it comes from the ENT side or the Audiology side, patients are “persuaded” to stay for hearing aids there at AAENT. I send these people in good faith to have the medical issues examined, we are taking care of their aural rehabilitation. This should be a non-issue to your office, at least from our point of view and I have to say ethically as well. If the patient wants to make another appointment with audiology to discuss hearing aids I can not stop that, but I would like it if I am (or anyone in my office) sending for a medical condition that not be discussed at that appointment.

I realize you all have a very busy practice, but the referral source should state that we have referred and we usually have the patient hand carry the audiogram. I have no issue with you re-doing the audiogram if you feel that is necessary.

I have had many patients get upset that AAENT is talking to them about hearing devices. I have worked with many of the audiologists who are employed there and feel this can be easily resolved, but want to make sure my view is expressed. I refer because I have to and I do what is right for the patient. I would very much appreciate your office doing the same.

You can call or email me if you have any questions or concerns.

Thank you,

The response was to AAENT’s credit immediate and effective. The head of Audiology called me and I did receive a letter from “Dr. Brown” stating he would bring this up at the next board meeting. I have received unsolicited information concerning patients that we share since this episode. I don’t expect that to continue since we have never received any correspondence from any ENT office in town after we refer, but I can always hope for the best. To counter act any chance the patient will stay with the ENT we set up an appointment immediately after the ENT’s and keep in touch with our patients that we refer out.

Part of me just feels this is a lot of work to prevent the “acquisition” of a patient at the ENTs office. Granted if the patient does not want to come back to us, they should not be intimidated to and we would need to change our procedures to make sure we help everyone in the most respectful way. But, in Private Practice this is one of my pet peeves, everyone should be respectful to those in the profession and put the care for the patient first.

Your thoughts?


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