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When in Doubt: Patient Demands and the Referral Process

After the physician reviewed the risks, benefits and alternatives of the procedure with the patient, he said, "If 'X' happens, and it happens in 20 percent of patients, I will send you over to 'X' as that is what they do best. I leave these procedures to the specialty teams." It was a statement, not open to discussion. Understood. No questions. No suprprises.

After the physician reviewed the risks, benefits and alternatives of the procedure with the patient, he said, “If ‘X’ happens, and it happens in 20 percent of patients, I will send you over to ‘X’ as that is what they do best. I leave these procedures to the specialty teams.” It was a statement, not open to discussion. Understood. No questions. No surprises.

It has become a common occurrence for patients to demand that physicians perform services they are not comfortable providing. Lack of professional respect for the healthcare provider seems to be more prevalent today than ever. Some patients don’t believe that “no” really means “no,” and they feel they can beg, cajole or threaten to get their way. While patients have a right be informed of their healthcare treatment and a right to refuse healthcare treatment, they cannot demand treatment. 

When these situations arise, there can be a conflict between a business decision and a clinical decision, especially if the procedure falls within a physician’s specialty but outside their everyday experience or comfort level. The physician may weigh the impact the decision will have on their practice (loss of perhaps not only that patient but also their family members and potential negative social media comments) with a desire to help the patient. However, if an unexpected outcome occurs, the result could be devastating. 

In these situations, remember that it is natural to be empathic and want to help the patient. The decision about whether to proceed can be gut-wrenching. As the physician, you have made a recommendation you feel is in the patient’s best interests. The patient has their viewpoint and the right to refuse the referral. Although the patient may not agree, it is imperative to use your good judgment. 

When, or if, an unexpected outcome arises, the patient/family will forget your hesitancy and recommendation to seek treatment from another source. If you document your recommendations for referral and then continue providing the demanded service, you may be damaging the ability to defend your actions. Just imagine a plaintiff attorney asking you to verify why you elected to proceed when you clearly had reservations.

It is best to advise the patient you are not the best person to perform the service. Others who provide the service on a routine basis are better equipped. You are not admitting your inability but that another provider is more skilled and knowledgeable with that type of service. Here are a few additional tips:

  • Document your discussion with the patient thoroughly
  • If the patient agrees to the referral, follow the protocols for an effective and timely referral
  • If the patient refuses the referral, have the patient sign an informed refusal form once you have verbally reviewed the risks, benefits and alternatives of not proceeding with the recommended referral 
  • Determine if the situation and patient’s behavior is critical enough to warrant dismissing the patient from your practice

If you have questions about the risks involved with patient referrals, please contact us.

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