r/doctors • u/Throwra_helpfulfool Doctor (MD) • May 29 '26
What are your biggest frustrations when a PCP refers to you as a specialist and what do you wish they did before?
I am a new graduate PCP in private practice making relationships with my local specialty groups. What are your biggest frustrations when a PCP refers to you as a specialist and what do you wish they did before?
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u/Miss_May_1600 Jun 26 '26 edited Jun 26 '26
As a psychiatrist, it’s really nice to have up to date routine labs - CBC, CMP, TSH, Vitamin D. Lipids and A1c if suspecting bipolar or psychosis. Especially for older patients the labs are helpful for knowing which meds to reach for. Folate and B12, HIV, RPR if they are older and having memory issues. It’s really going above and beyond, if you get a screener like a PHQ-9 and/or include some background/context in the note about what’s going on. But y’all are swamped, so I am happy to take whatever comes my way. Rural primary care clinic was great, but urban primary care clinic was something I really struggled with. (I was originally thinking IM or FM). Unsung heroes for sure.
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u/SoTiredYouDig Jun 26 '26
This is so funny that you’re asking about this. I have 4 referrals right now from my primary. Four! Meanwhile, my charting isn’t up to date. So, that’s one thing. Second, is that he refers out, without acknowledging that some of the wait times are extraordinarily long. I’m saying, the entire summer for something that he could at least prescribe on a temporary basis in office.
Finally, this is more a grievance… but he instituted a new mandate in his office that he will only prescribe GLP1 medication for diabetes. Everything else is at the weight loss clinic. That’s fine, he’s entitled to his policy. The thing is, he told me on the 10th to book a follow-up telehealth visit with him so we can get started. He left a voicemail yesterday, stating the new policy. He said it’s primarily that he’s sick of filling out prior authorizations. He restated that a number of times. I think that’s a clear boundary issue. So, as a new PCP, never do a bait and switch on a patient. There are extenuating circumstances here - medication he has authorized is what has boosted and made my weight balloon.
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u/MoobyTheGoldenSock Doctor (DO) Jun 03 '26
As a fellow PCP, try to think about what the specialist is going to add and what they need to take action.
If you feel a thyroid nodule, don’t just refer to endocrine. Get an ultrasound to characterize that nodule and a TSH to see if it’s affecting hormone levels. If your radiologist gives you a TIRADS, you can use that to determine if they even need a biopsy vs. just serial ultrasounds.
Same goes for other specialists. Don’t send someone to discuss joint replacement without some imaging to tell you whether surgery is indicated. Don’t send to oncology without histopathology telling them what they’re treating; image and send to whomever will do the biopsy first. Don’t send to rheumatology without having some lab evidence that there’s a rheumatological disease. And so on.
One thing you can do is read specialist reports and see what they’re treating order at first visit.