In general practice, patients often require care beyond the primary setting, but for the veterinarian, knowing exactly when to refer these patients can be difficult. Each case is unique, and referral time will depend on many variables, including case urgency, client preferences, client finances, and your comfort and experience treating the particular ailment. Consulting with a VESPECON specialist early in the case can define the referral timeline and ensure you’re on the right track with diagnostics and treatment. If you still aren’t sure, consider the following situations, which may prompt handing over the reins to a specialist.
#1: When you need advanced imaging, equipment, or facilities
You may sometimes send your patient for outpatient imaging or procedures to confirm a diagnosis and then continue to manage the case yourself, but most cases that require advanced imaging are considered more severe or complex, and benefit from specialist intervention. Referral through the appropriate department will ensure the correct imaging is ordered—for example, is MRI or CT better for this patient?—and will allow the specialist to present all treatment options directly to the client.
#2: When the diagnosis is unclear
If you’ve ordered all the tests you can think of and tried reasonable preliminary treatments, but you still can’t reach a diagnosis, send the patient for referral. The longer your patient waits, the more likely their condition will deteriorate. Most empirical treatments aren’t harmful, but some can interfere with future diagnostics or other treatments (e.g., giving prednisone to a patient with lymphoma), and a quick specialist consult can prevent these mishaps.
#3: When traditional treatments don’t work
If you have a solid diagnosis, but first-line treatments aren’t working, a specialist can help you think outside the box and consider variables you may have missed. Veterinary specialists have treated the same condition in multiple patients over many years, and know more about the treatments that are more likely to work for specific patients. They’re also on the front lines of new, experimental treatments, and can often include patients in clinical studies when all else fails.
#4: When your patient is unstable
Eventually, your patients with chronic conditions will arrive at your clinic in a decompensated state. If your seizure patient has a cluster or your heart failure patient becomes oxygen-dependent, they’ll need 24/7 care and monitoring after they’re stabilized. Post-operative patients often benefit from overnight care if they need continued pain control, experienced anesthetic complications or extensive bleeding, or need frequent blood value monitoring. Patients who are admitted through the ER see a criticalist right away, and they’ll be closely monitored in the ICU. If the patient requires specialty consultation, they’re often the first to see the specialist in the morning.
#5: When patients have multiple conditions
Patients who develop multiple complicated conditions often have competing clinical needs that can be challenging. If your patient has arthritis and elevated liver enzymes, NSAIDs can’t be used, and if your patient has chronic IBD but is also diabetic, steroids are off the table. Internal medicine specialists often manage patients with multiple conditions, and understand how to balance their treatment and effectively deal with side effects. When these patients need anesthesia, the specialist generally can best determine risk versus reward.
#6: When you know you’re in over your head
When you’re considering a referral, first and foremost, be honest with yourself. What are your clinical strengths and weaknesses? Where are your knowledge gaps? What are you uncomfortable treating? If you know your patient would be better served if a specialist was involved, put away your ego, and put the patient’s needs first. Referral isn’t “giving up”—referral is your chance to collaborate with a specialist who can help you learn from each case and better manage your future patients.
When in doubt, refer sooner than later
Referring a patient too soon is almost impossible, but you can certainly refer too late. Tumors get larger, cancer spreads, tissues degenerate, and organs become more dysfunctional as diseases progress, so if you are unsure about your patient’s problem, or you know they’ll probably need advanced care—refer sooner rather than later. Many specialists have long waits, so the sooner your patient is added to their list, the better.
VESPECON offers virtual specialty consulting services and an in-person network of specialists for referral. Our consulting specialists are available on demand to walk you through your complex cases, and will let you know when the patient should be referred. If you’re interested in learning more about VESPECON’s services, contact us to get started.