A primary care provider should refer a patient to a specialist when the patient’s condition requires skills outside their expertise or the patient has a complex/persistent issue. A referral should also happen when the physician needs a second opinion, for example, to confirm a diagnosis /treatment plan, or when a patient wants one.
However, not all cases that need a referral are handled properly. Here are two referral errors reported in the medical field:
Inappropriate referral
A physician may refer a patient to a specialist who is not qualified to treat the patient’s specific condition. This can happen due to cognitive bias, which is when a doctor relies on initial ideas, ignoring contradictory data, sending the patient to a specialist who treats the condition they initially thought, or makes a referral based on a recent, memorable case they handled.
Other factors that contribute to wrong specialist referral are poor communication, overconfidence and system issues.
Referring a patient to a specialist who is unlicensed, too busy to see a patient or with a record of disciplinary action or professional censures is also inappropriate. This typically happens when a physician fails to obtain enough information about a specialist.
Further, it’s unlawful to refer a patient to a specialist in a practice where the primary physician has an investment interest. It creates a conflict of interest. It’s also inappropriate to delay a referral or make an unnecessary referral.
Failure to refer
A physician who fails to refer a patient whose situation warrants it breaches their duty of care. A patient can suffer serious consequences from such a mistake, including worsening of a condition, permanent disability or death.
A referral error can result in significant physical, psychological, and financial damages. If you or your loved one suffered harm due to such an error, understanding the legalities of your case can help you understand your options.