When it comes to referrals, the right specialist may be closer than you think

Optometric Management, Jun 2006 by Luthe, René

KEEPING IT IN THE FAMILY

When it comes to referring your patient to a specialist, M.D.s are not your only option. Many optometrists are qualified to handle complicated ocular conditions, from challenging contact lens cases to eye disease. Whether you need to find an appropriate practitioner to refer to, or get referrals yourself, here are the issues you'll need to consider.

Why go to another O.D.?

When optometrists think of making referrals to colleagues, they typically think of M.D.s. (A complete list of conditions that are appropriate to refer to M.D.s is included in the feature "A Complete Guide to Referrals," which begins on page 76.) When the patient needs surgery or treatment for eye disease, this makes sense. However, there are also many situations in which sending a patient to another O.D. not only benefits that patient, but your practice as well.

Just like an M.D., another optometrist may have specialized knowledge that you don't. Kenneth A. Lebow, O.D., F.A.A.O., of Virginia Beach, Va., points out that visual training or developmental vision are specialties he will refer for. Neuro-retinal cases, such as retinitis and optic neuropathy, and systemic issues also qualify. "An excellent example of when to refer to another O.D. is when the practitioner has limited experience with keratoconus or post-refractive surgery contact lens fittings," Dr. Lebow says. Referrals for these situations should occur more frequently than they do, he claims.

Another important reason to find other optometrists to whom you can refer your patients is to get coverage for an emergency when you are out of town or otherwise unavailable. This is critical, Dr. Lebow says. "It then becomes a reciprocal relationship."

William L. Jones, O.D., of Albuquerque, on the other hand, covers many of the problems M.D.s typically do. Nearly 12 patients are referred to his office on a weekly basis. His referral-only practice treats patients with glaucoma and performs retinal evaluations, such as age-related macular degeneration, diabetic retinopathy and retinal breaks. He gets referrals for such cases because he has made himself an expert. "I've been involved in cases such as these since my residency in 1977," Dr. Jones says. "I decided to open a practice specializing in them to help fellow O.D.s with eye-disease patients."

Building your network

How can you find qualified O.D.s like Dr. Jones to whom to refer your patients? It's a more sociable experience than you might think. "It's as easy as getting to know the practitioners in your area," says Dr. Lebow. Find out who handles what, he advises, and be sure to ask what the practitioner feels most comfortable doing.

Dr. Jones incorporated a more formal approach as well. He says that shortly after opening his practice, he hosted an open house to answer questions.

Play fair

Getting your patient back after you've referred him or her to a specialist has always been a major concern for practitioners. Dr. Jones says that sending the patient back to the referring optometrist is always his policy. He provides a detailed report back to his colleagues in the form of a written report and a PowerPoint presentation with all of the tests he performed on the patient. He says he sends these reports as soon as possible so the referring O.D. knows that the cases were treated promptly and taken seriously. Dr. Jones also often calls the referring O.D. with an update the same day he's seen the patient.

Rather than take that level of conscientiousness for granted, Dr. Lebow recommends discussing the matter with the specialist prior to the referral. Making it clear that you expect the patient back once the treatment is completed is critical, he says.

As a contact lens specialist, Dr. Lebow explains, "When a practitioner refers me a contact lens fit due to its complexity, I typically return the patient to the referring doctor to get glasses that can be interchanged with their contact lenses. The original O.D. does the eye health exam and I evaluate the contact lenses." He warns, though, that every once in a while, a patient does choose not to return to his or her original doctor.

Get started

If you're ready to begin your referral network, there's no need for lengthy preparation. Dr. Lebow advises simply picking up the phone and calling the O.D. you're considering to handle your patient's care. Remember to have that discussion about returning the patient to you once the treatment is completed. Find an optometrist who makes you feel comfortable with the relationship.

If you want to receive referrals, then you do need to do some preparation. Not only does this require extensive knowledge of a given specialty, but, "Then you have to build a reputation upon your knowledge," Dr. Jones says. He recommends publishing or lecturing on your area of specialization to boost your image in the community.

For your referral network to succeed, be sure to keep it a two-way proposition. "Too often it is a oneway street," says Dr. Lebow. "When this happens, referrals fail and feelings get hurt."