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After reading my last post on “How to Add Patients to Your Hospital”, Dr. Jet Comia sent me this reply to air his sentiment on the referral system here in the Philippines.  Here was his comment:

Based on my personal experience of running a primary care hospital for the last six years, there is not much support or “gratitude” coming from Tertiary hospital giants. Worst is instead (of) thanking (you for your) referrals, you have a greater chance of getting comments like “This is a wrong diagnosis”, or “The treatment that should have been done is…”, or they don’t even read referrals anymore, and doctors just to win patients would not care to explain the life saving measures you have done. Where is the refer back slip thanking you or (saying) “This is what we’ve done”, etc… Anyway,  I guess doctors, not all of them, once they reached the status of the rich and richer, (are) more concerned (with) the payback fee…So primary care doctors are very much overlooked and ridiculed.

Most of the hospitals who desire to have a higher market share would try to invest in sophisticated machines and employing medical specialists.  They would increase bed capacity and add new services.  They spend a lot on improving brand identity, image, and customer satisfaction.  While there is nothing wrong with these initiatives, the bottom line is this: the general public does not think about which is the best hospital – until disease strikes.  And who do they go to when this happens?  Chances are, most people would choose to go to their trusted primary care physician.

According to an article published in The New Zealand Medical Journal, only 14% prefer to see a specialist first when they need to see a doctor.  This phenomenon does not only happen in the Philippines and New Zealand, but in a good number of other countries as well – even if primary care physicians are not mandated as gatekeepers.*    Thus, for hospitals and specialists, it is crucial to exert effort to maintain an ideal relationship with local primary care physicians.  As a Family Physician and Palliative Care practitioner in a tertiary hospital, I actually get to be a primary care provider and specialty physician at the same time, so I  have an idea on how to work on both ends of the spectrum.

So what must a specialist or a hospital do to attract referrals?  Here are some suggestions.

1.  Treat primary care providers with respect.  Never show superiority of knowledge to a primary care physician when they refer patients.  Instead, view them as partners in the health care continuum so that they would refer more patients to you.  And make it a point, if possible, to teach them and add to their knowledge and competence.

2.  Know the referral practices of primary care physicians.  Find out where and how they practice, and ensure a smooth transition when they send patients to you.

3.  Acknowledge the referrals and provide feedback.  It is unprofessional not to return a referred patient to the primary care provider.  Being rude may put your livelihood at stake.  Word of mouth spreads fast, and you may find yourself staring at the ceiling and salivating at the clinic of the EQ-laden physician or hospital next to you.

Peter Drucker once said that the prime directive of a business is to acquire and keep a customer.  And it is still the referral of the primary care provider that enables specialists and hospitals to succeed.

* Patient Preferences for Care by General Internists and Specialists in the Ambulatory Setting by Lewis, et. al.  J Gen Intern Med. 2000 February; 15(2): 75–83.


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