hi! I have a question for you guys! How do decide when to refer a patient to a internalist? I know when it`s for harder cases and internal diseases but I`ve been working with one for the past few months and a lot of their cases are cases that dont seem to be all that off for the the cases that the other doctors get. As in yeah they`ll get a cushings or imha case but I know the other dr have diagnosed them as well. Would they be refered to when the cases arent presenting as the normally would?
Ferox here.
Locally the internal medicine specialists are really, really busy. Internal medicine is one of those fields where everybody kind of thinks they can do it like the pros but in practice the skills of individual vets, and the equipment they have available, varies wildly. Not every clinic even has an ultrasound machine.
I will never deny a client a referral to a specialist if they request one. That’s a fast route to leave yourself exposed for litigation so if someone wants a referral, even if I’m confident I could handle this case, I write them one anyway. It’s always interesting to read the reports and see what’s new.
It’s also worth paying attention to the type of clients you see with internal medicine specialists. Most of the cases I push for referral are brain/neurology cases because I just don’t have the imaging available to me, or completely out of control cases that are ‘weird’ in some way. But I have also just sent specialists anxious clients because once a pet owner has gone to every local clinic seeking a second, third, fourth, fifth etc opinion on their pet, their next opinion might as well be a board certified specialist.
Some of these cases then choose to continue seeing the specialist even when they are back under control and something I could handle routinely, but I still wont dissuade them from seeing the specialist. Some will have also been sent to the specialist through an emergency department and then never quite seem to find their way back to general practice.
So as a general guide, I send cases to internal medicine specialists when:
I need a test or imaging done that I don’t have access to in my clinic (eg brain scans)
The client has sought multiple opinions on the case already and will probably seek more after me
The client requests referral
We’ve done some testing and are either going to hit a dead end or reach that point where I need to do 5 expensive tests and you might as well spend that money at a specialist at that point.
It’s genuinely weird (and the threshold for ‘weird’ for one vet will be different to the next vet’s)
