Do FPs cause delays in other specialists’ wait time?

Several years ago, a colleague asked me to cover his absence for two weeks by reviewing his patients’ test results only. I was surprised by the large number of referrals he made to other doctors for reasons that I do not feel necessitated consults: A man in his fifties was referred to a surgeon because of gall bladder sludge. A woman in her twenties was referred to a gynecologist because of bacterial vaginosis. A nine-year-old child was referred to a pediatrician for lactose intolerance. A young man was referred to a sexual clinic for herpes simplex type 2. ...and many more. When I reviewed the consulted physicians’ reports, I did not find anything different from what family doctors do in most of the cases, and the vast majority of them concluded with some variation of the sentence: “We did not book a follow-up appointment for your patient and we will return him/her to your care.” I asked him one day the reason for these referrals in case there was a reason behind each referral that I was not aware of. His answers varied: either that the patient had asked for it, or to avoid having any responsibility or for better management. Read: Dr. Jabir Jassam: Dr. Yes A few years ago, I was on vacation for two weeks and asked a colleague to see my patients during my absence. After my return I was also surprised by the referrals my colleague sent for cases that have been under my care for several years, such as chronic back pain, acne and benign skin moles, and other cases that I do not refer to other doctors except when I need a surgical intervention or other opinion or plan that I don’t know or can’t do. I was in a shared office with a colleague, he heard me talking to a mother of one of my patients, a 12-year-old boy whom I was managing for nocturnal enuresis. He asked me after he noticed that I spent a long time with his mother over the phone “What is wrong with this child?” “Nocturnal enuresis.” “Send him to a pediatrician.” “What would the pediatrician do?” “I don’t know, but he might have something which caused the bedwetting.” “I had all the tests done on him and they were all normal.” “Refer him to a urologist.” “I don’t think it is a urology case and it would take one year to see one and all his tests were normal.” “What is wrong with him then?” “He has anxiety since his parents got divorced and he’s still unable to accept that so he struggles psychologically.” “Refer him to a psychiatrist.” “He is on DDAVP (desmopressin), seeing a psychotherapist and he is responding well but slowly.” “Oh, you gave him DDAVP?” “Yes, I did, why not?” “Why are you taking such risk by yourself?” “Yes, DDAVP has side-effects as any other medication but it doesn’t mean we don’t use it, and with close observation and follow up, we can minimize or manage these side-effects.” “That means you will not be referring him to anywhere.” “Not really, as long as I know the reason, but I will if my treatment fails—which hasn’t so far.” I asked him: “What would you do if this child was your patient?” “I would have referred him from the first visit to either a pediatrician or a urologist,” he immediately replied. He noticed my dissatisfaction with his answer then he turned his face away from me and got busy with his computer. I understand that everyone is different, and the more referrals, the less liability but some of us seem to go beyond reasonable limits. Avoiding unnecessary referrals allow for serious cases that actually require referrals to be seen faster. I do not claim to be innocent of unnecessary referrals. I have done it; I have referred patients that I should not have referred. This happened mainly when I started working in Canada, and most of these referrals were due to my lack of knowledge of the health system. I think that after several years of practice, our judgments should be better in many areas particularly about when and why we refer some of our patients to other doctors. I believe with increased experience and practice, the number of referrals should automatically decrease. Unnecessary referrals prolong the wait times of other doctors, but also the wait times of family doctors themselves because—besides the time consumed writing, attaching files and faxing the referrals—they may need to read all the incoming reports. In my opinion: The wait time for some specialists is very long for many reasons and family doctors are one of these reasons. Dr. Jabir Jassam is a family physician in Ottawa.

Do FPs cause delays in other specialists’ wait time?

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