A Matter of Mutual Respect and Trust
The issue of referral or receiving referral cases is of concern for all veterinarians. With the rapid growth of veterinary specialty practices, there is an obligation to provide all options available, including the option of referral.
General practitioners usually refer a patient to a specialist for several reasons, the first being their own comfort level with a particular procedure. If the surgery involves a technique that the practitioner does not perform on a weekly basis or does not have ready access to or familiarity with the required instrumentation, the veterinarian should offer referral. The general practitioner should also assess their level of expertise, skill and experience, along with owner expectations, when considering the best care for the patient.
It should be noted, however, that the general practitioner enjoys many marked advantages over the specialist. First, and most importantly, the general practitioner usually knows the animal and is more adept at picking up subtle changes in behavior or signs of malaise, pain or distress. In addition, being the animal’s primary care physician, he/she is also an excellent resource regarding the medical history and is attuned to any drug reactions, dietary needs and/or habits. Finally, the general practitioner knows the family unit, the home environment, the lifestyle and the various personalities within the household, which are enormously important factors when considering surgical options and their associated postoperative care.
And what about the specialist to whom cases are referred? What are his or her obligations? Surgeons are responsible not only for performing surgery but also for overseeing perioperative and postoperative care. Just as important as the surgery itself is perioperative care: the diagnosis, assessment and supportive care before and during surgery. Postoperative care involves intensive monitoring and assessment of a patient, bandaging, pain management and rehabilitation (veterinary form of physical therapy). Specialty surgical clinics have special facilities for these aspects of care.
However, first and foremost, the specialist has a moral obligation to stay in good communication with the referring clinician, keeping him or her apprised of case development and using his or her knowledge of the client’s situation to assure compliance with treatments and regimens and to seek counsel. Furthermore, just as a primary care veterinarian has an obligation to refer when it is in the best interest of the animal, a specialist has the obligation to return the client to the primary care veterinarian for that animal’s general veterinary care. Paying due diligence in returning the patient is more than just a common courtesy. It assures mutual respect and trust – which is the foundation of a true partnership. It is imperative that the specialist partner with the referring veterinarian to provide the best possible care to the owner and animal.
Dianne Dunning, DVM, MS, Diplomate ACVS
North Carolina State University, College of Veterinary Medicine
Member, ACVS Foundation Board of Trustees