In today’s health care model, which is largely dictated by the requirements of health insurance companies, self-referral for specialist care is very rare. Typically, in order for health insurance to cover expenses related to specialty care, a patient would need a referral from their primary care doctor.
Usually, a patient’s primary care provider would assess the patient’s symptoms and determine whether a specialist (such as a cardiologist or pulmonologist) consultation is needed. If specialty care is deemed necessary, the primary care provider would then give the patient a referral to see a specialist. The downside of such a model is its discretionary nature. Even if a patient requests a referral, their primary care doctor may refuse to give it.
If you feel you need additional assessment and treatment by a specialist or additional testing, and your primary care doctor will not refer you, it may be due to some or all of the following reasons.
Your doctor made a mistake. Physicians are human and therefore capable of making a mistake. They can dismiss symptoms that should be taken more seriously, or they could have misdiagnosed the cause. In fact, in today’s stressed and compressed medical climate, medical errors are actually on the rise.
It may be implicit bias. Without even being conscious of it, your doctor may not be taking your symptoms seriously because of assumptions they are making based on factors such as your sex, race, or age.
Your provider may not like the idea of a second opinion. Some doctors view a request for a second opinion as a loss of faith in their ability to diagnose and care for you. And, in the high-pressure world of medical care, it may be difficult for your physician to set their ego aside and admit they may have been mistaken in their initial diagnosis.
It might be a failure to listen. With an average of just a few minutes with each patient, doctors may not do the active and intent listening needed to fully understand what their patients are telling them, let alone ask the right questions. In other words, they may be short on time.
Your doctor does not treat you as a care partner. No one knows your body better than you. If your doctor does not treat you and the concerns and information you share with respect and consideration, it can negatively impact the quality of their decisions regarding your care, including when to make a referral.
If you find yourself in a situation where you are experiencing concerning or chronic symptoms, and you feel your physician should refer you for a second opinion, evaluation by a specialist, or for more in-depth testing, but your doctor refuses, you must advocate for yourself. You can ask them why they will not refer you and request they reconsider. If they still refuse, you may want to think about finding another primary care provider who is a better fit. Your health and well-being deserve the best care possible. If you or a loved one has been harmed by a doctor’s failure to refer, talk to us.