The Dangers of Ignored Referrals and What You Can Do About Them

Like the proverbial horse that refuses to drink, a significant percentage of patients choose not to follow up on the referrals they’re given by their physicians. And providers typically don’t have the resources to lead patients where they don’t want to go.

Who’s to blame for that situation?

“It’s really the patient’s responsibility to make the appointment and follow up with the doctor,” says Ann Whitehead, RN, JD, a vice president for the Cooperative of American Physicians, Inc., a physician-owned medical liability firm. All physicians can do, she adds, is make the referral, explain everything about it to the patient, and document the discussion.

But as blogger and patient advocate Barbara Jacoby points out, rather than blithely disregarding their physicians, some patients with fixed or very limited incomes may silently be facing tough choices. “It may be a matter of spending their cash on medication, or food, or paying the rent,” she says. “While the Affordable Care Act was created to offer a chance for every single American to have health care … I know several individuals [who can’t afford] this protection, even with reduced or subsidized payments.”

Unwieldy system

Beyond the blame game, as every physician knows, even when patients follow through, the referral system can be problematic. “There are breakdowns and inefficiencies in all components of the specialty-referral process,” one study concluded. “Many referrals do not include a transfer of information, either to or from the specialist; and when they do, it often contains insufficient data for medical decision-making.”

As a result, physicians also often end up pointing fingers at each other. “[Primary care physicians] often do not know whether a patient actually went to the specialist, or what the specialist recommended,” the researchers say. “PCPs and specialists also frequently disagree on the specialist’s role during the referral episode” —  whether, for example, the PCP has a single consultation in mind, or continuing co-management.

The Institute for Healthcare Improvement agrees that “the referral process is often hindered by ambiguity of roles, communication breakdowns, clinicians’ workloads, and variations in requirements among specialists.

“Such difficulties,” it adds, “can lead to missed or delayed diagnoses, delays in treatment, and other lapses in patient safety”.

The litigation threat

Therein lies a serious danger for providers. Lawsuits related to missed follow-ups are increasingly frequent, Beth Cushing, vice president of claims for medical liability insurer CRICO, tells American Medical News.

The claim is “lack of informed refusal,” says John Davenport, MD, a physician risk manager. Patients may admit they ignored treatment recommendations, but insist they weren’t adequately educated about the medical risks of their decisions.

“Lack of informed refusal; that’s a new one for me,” the blogger Skeptical Scalpel says incredulously. “Whatever happened to personal responsibility? I guess it’s always someone else’s fault when anything goes wrong.”


Regardless of how you judge or apportion blame, it’s good to know that you can now call on a much more efficient and dependable referral system. LiveReferral, a secure cloud-based referral-management platform, provides real-time communication, so care teams can view provider availability and schedule appointments before the patient leaves the office or other clinical setting.

That’s crucial, because studies show that patients are 60 percent more likely to follow up with their referred appointments if they’re scheduled in the clinical setting.

Meanwhile, for patients, the opportunity for a hassle-free, point-of-care referral results in a much more satisfying experience.

Created by doctors for doctors to make sure patients see the right doctors, right away, LiveReferral:

  • increases revenue by allowing providers to keep more referrals in the network;
  • ensures quality of care throughout the care continuum by keeping patients within the appropriate network;
  • enables care teams to communicate notes and clinical data through secure modules; and
  • streamlines follow-up with patients for compliance.

It’s the referral functionality that providers would love to have — if they knew it existed.

Michael Murphy, MD
Dr. Michael Murphy is co-founder and Chief Executive Officer of ScribeAmerica, LLC. He co-founded ScribeAmerica in 2004, and it is now the country’s largest and most successful medical scribe company with a staff exceeding 7200 employees operating in over 46 states nationwide. Today, ScribeAmerica is the recognized leader of the medical scribe industry and remains at the forefront of professional scribe education, training, and program management nationally. Dr. Murphy served as an Army Ranger for the 1st Ranger Battalion in Savannah, Georgia, which allowed him to gain various leadership skills along with the ability to develop standard operating procedures. He applies this to his daily duties for ScribeAmerica. Dr. Murphy has been a leader on multiple issues including scribe policy, hospital throughput, electronic medical record implementation and optimization of provider to patient ratios. His goals are to continue making all medical practice locations an environment built for an exceptional patient experience that allows providers to focus solely on patient care. Dr. Murphy received his Doctor of Medicine from St. George's University and completed his residency training in Emergency Medicine at the University of Medicine and Dentistry of New Jersey in Newark. He has co-authored one textbook and is involved in 3 peer review articles.
Posted In: Future of Healthcare, General, Quality, Efficiency, Utilization, Queuelogix On: Wednesday, 5 June, 2019

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