Specialists are new graduate's ally


Specialists are new graduate's ally

Critical to a budding relationship between generalist and specialist is knowing when to refer; patient welfare first
Apr 01, 2004

At some point early in a new graduate's career, he or she will stumble upon a patient case that's hardly the textbook variety.

When such a scenario arises, and generalists and specialists agree that it's inevitable, both parties offer similar baseline advice: know when to refer.

When managing a complex case, the specialist may say veterinarians can't refer soon enough; while the general practitioner typically views the referral as one of several options.

But the experts agree: first consider what's best for the patient, then make the referral decision.

"If there's something a new graduate feels they can't handle, they need to at least offer the referral," says Dr. Alice Jeromin, board-certified dermatologist in Brecksville, Ohio.

Daniel Brogdon, DVM, board-certified veterinary ophthalmologist in Jacksonville, Fla., agrees that when new graduates are seeking to forge a relationship with their local specialist, his best counsel: "Refer early and often."

"When you refer a case to a specialist, it is a win-win situation in which the pet gets high quality medical care and you get the credit for the referral," he says.

But Dr. Tom Mann, general practitioner in Akron and outgoing president of the Ohio Veterinary Medical Association, says referrals shouldn't be a quick fix.

"Students need to do everything that their training and capabilities allow them to do first. If this (procedure) is something I'm not comfortable with or qualified to do, then refer it. Don't look at something right away and say I can't do this. How are they ever going to learn?"

He speaks of concerns that universities are filled with specialists, who are training students to "do nothing but refer." "They're not being taught you're going to see this broken femur, and you have the capability to fix it. Instead, it's 'you don't have any business doing this, you better send it out.' "

While he agrees there's many a time and place for referrals, he says it's imperative that students master the ability to discern that consideration.

When money's an issue

Clients' economic issues can play a negative role in the referral process, according to Jeromin. She says more than once, veterinarians have told her they "would've referred sooner, but the owner doesn't have the money."

But when she probes the case deeper, she says she's disturbed by what she finds. "The veterinarian has already run all these extraneous tests on the animal. If I had seen that patient sooner, I never would have run those tests. Who's spending that money?"

If money truly is an issue, Jeromin says she wants to clarify that she is the client's "buddy" in trying to save them a buck and advises referring practitioners to find out her true costs before making a snap judgment call for their clientele.

Adds Brogdon, "Don't make financial assumptions; let clients know if a referral is best for your patient. Let the client make the decision."

Mann agrees, "Be very careful that you don't let money make the decision – you have to advocate what's best for the pet."