Referrals: It’s the Money

It is incredibly frustrating to need a doctor and have a referral, yet be unable to get an appointment.

It is maddening to know that if I’d consented to inpatient surgery, all of this would have been resolved in September.  September.  It is now November.  Never again will I attempt to keep expenses down and get out of the hospital as soon as possible.  It is not efficient to try to do things on an outpatient basis.

The gastroenterologist to whom I was referred determined that I need a highly specialized procedure that he doesn’t perform.  He sent a referral to the new GI (let’s call him GI#2) and told me that the new place would call me to schedule an appointment.

I’ve written about this before.  The short version is that after a week without hearing anything, I followed up.  Even though they had all my paperwork, they wouldn’t schedule an appointment.  I was told it would be another 1-3 days before that could happen.  It wasn’t.  A second week went by, then I followed up again.  Still no appointment.  I was told to be patient.  GI#1′s scheduler called me to schedule my follow-up with him since I should have seen doc#2 by now.  Finally I called my gastroenterologist’s (#1) office again and asked if they could please refer me to someone who will actually make an appointment to see me.

Another day, no word.  And another.  I started making phone calls.  There are  doctors much closer who do this procedure.

I phoned my family physician’s office and explained the situation.  “Would it be possible to get a referral to someone else?”  Yes.  “Can I make an appointment so that you can be paid for doing the work?”  No.

My family physician’s office asked which doctor I wanted to see.  I picked the one who had said they could try to work me in this week.  Referrals don’t happen instantaneously; I was told that it would take a day, so I waited two before phoning to make an appointment.  They couldn’t find my referral, but did find my name in their computer so made an appointment and said they’d track down the paperwork.  Good people.

Did I have to wait a week?  Two weeks?  Three?  No.  If it worked for my schedule, they could see me the next day.

A few hours later my phone rang.  It was GI#2′s office.  Once they have a referral, it takes them more than three weeks to bother contacting the patient to set up an appointment.  Caring nothing about my calendar and existing commitments, or the fact that my stomach hurts any time I try to eat, they issued a summons to appear in their office two weeks hence.

I politely accepted the appointment (hedge my bets – I’d hate to say no thanks  after all this time and then discover that there really is only one person in the state who does this procedure), but the following day I met GI#3.  They can  do the procedure and I don’t have to drive to BigCity.  They even gave me a choice between a few dates and will contact me once they can arrange anesthesia.

A few hours after I returned home from meeting GI#3, GI#1′s office phoned and said that the doctor had written a referral for me to see… the local guy?  another local guy?  No.  GI#4 is another doctor in BigCity.

I was starting to wonder if perhaps GI#1 lives in BigCity and commutes, the way he keeps wanting me to go there as if it’s right next door.  Instead, a recent post on KevinMD makes things quite clear:  Why Patients Get Unnecessary Referrals to Consultants.  GI#1 works for one hospital system.  GI#3 works for a competing system.  My rheumatologist has already told me that they’re not allowed to refer outside the system.

WHY is it about whose employer gets the money, instead of being about what’s best for the patient?

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This post was published in November as part of NHBPM’s – 30 health posts in 30 days

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2 thoughts on “Referrals: It’s the Money

  1. Oh my. It’s a good thing you’re both tenacious and determined because it doesn’t appear that anyone else was doing their job. You have every right to be angry. Makes me very, very glad that I live in a large city and all of my doctors are associated with the same hospital. (Yikes!)

  2. That’s just awful, Socks. I’m glad you were able to see GI#3 and that the appointment went so smoothly. I hope the next step goes as well so you can get this thing done and get it behind you. Sending hugs your way.

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