When a doctor does not refer a patient to a specialist for additional care, further diagnostics, or for treatment that only another physician can provide, they may be considered liable for negative consequences if the patient suffers as a result.

When a doctor does not provide a referral in time or at all, the patient may suffer serious complications, including:

• Delay or failure to get a diagnosis
• Delay in treatment
• Worsening or additional health conditions
• Worsening or additional symptoms
• Additional medical expenses
• Pain and suffering
• Emotional distress
• Hospitalization
• A need for surgery
• Loss of ability to work
• Temporary or permanent disability
• Death

Recognize When It’s Time to Refer
The need for a referral to a specialist can arise at any time during the treatment of a patient, from initial evaluation through the end of care. It is important to recognize the need for a referral when it first arises. Does the patient have unmanaged comorbidities? Is the patient unresponsive to the treatment plan? Did the patient develop a complication? Is the patient questioning your care and treatment?

Don’t Forget to Document
Your documentation in the patient’s medical record is crucial in the event a patient brings a lawsuit against you alleging failure to refer. It is important to document the patient’s specific medical history, social history, complaints, questions or concerns, physical examination findings (both positive and negative). If abnormal findings or concerns are present, promptly document the findings or your concerns and inform the patient. Then document your rationale for your decision to refer or not to refer for further evaluation or treatment. 

Document who or where you referred the patient, the date of the referral, and the date of the appointment. If it is an emergent or urgent referral, it is prudent to call the provider to whom you are referring to discuss your reason for the referral and the urgency of the referral, and then document your conversation.

It is also important to have a system in place to log referrals to ensure that the patient kept the referral appointment, that you received a report from the referral provider, that you reviewed the report, and that you followed up on any recommendations or changes to the treatment plan so that the patient does not “fall through the cracks.”

Handling a Patient Who Refuses the Referral
If the patient should refuse a referral, ensure the patient understands the risks of refusal. Explore the reasons behind the refusal. The patient may have financial concerns, fear, misinformation, and personal values and beliefs. You may also involve family members and caregivers, with whom you are authorized to discuss care, to assist in helping the patient to understand the importance of referral. Ultimately, it is the patient’s decision. If the patient refuses the referral, document the patient’s refusal and all discussions with the patient regarding the risks and benefits of the referral.

When to Consider Terminating a Patient
To protect yourself from professional liability, it is important not to start or continue treatment of a patient who may suffer adverse consequences if they do not have further evaluation and treatment, which may mean you need to terminate your physician-patient relationship. To reduce the risk of allegations of patient abandonment, it is important to follow a formal process for termination of the relationship that is respectful, optimizes continuity of patient care and patient safety, and follows state laws and regulations regarding written notice, emergency care, and referrals. Download a sample Patient Termination Form here.

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“OUM” and “OUM Chiropractor Program” do not refer to a legal entity or insurance company but to a program or symbol of a program underwritten, insured, and administered by ProAssurance. The information contained on the OUM Chiropractor Blog does not establish a standard of care, nor does it constitute legal advice. The information is for general informational purposes only. We encourage all blog visitors to consult with their personal attorneys for legal advice, as specific legal requirements may vary from state to state. Links or references to organizations, websites, or other information is for reference use only and do not constitute the rendering of legal, financial, or other professional advice or recommendations. All information contained on the blog is subject to change.