Question about physician referrals

Factual Questions
1

I recently moved to a new city, by which I mean back to my old city of Roanoke, VA after a stint in the DC area. The day before I left, I went to my dentist for a final appointment. At the end of the appointment, she wanted to give me a referral to an oral surgeon for an issue I was having. She said, “I’m going to give you a referral to Fairfax Oral Surgery to handle [issue].”

I said, “Oh, I’m not going to be able to go to Fairfax Oral. Like I said, I’m moving tomorrow.”

My dentist: “Right, but you need to see an oral surgeon, and they’re the ones we work with.”

Me: “I understand, but I’m not going to be able to see them. I’m going to need to see an oral surgeon at my new location.”

Her: “I get that. I’m going to give you a written referral. I’m not going to send it into them.”

Me: “A written referral to Fairfax Oral Surgery?”

Her: “Yes. They’re who we work with.”

Me: “But I’m not going to be able to see them.”

This Who’s-On-First routine went on for over a minute before I finally clocked was that her point was that I could take the written referral to Fairfax Oral Surgery to the oral surgeon of my choice in my new town. She was taking for granted that this was obviously true. And, sure, it is, just like how a recommendation to use Tide laundry detergent works as a recommendation to use Cheer, or a 50% off coupon at Stefano’s pizza can be taken to Milani’s and work just as well. It’s a very intuitive concept.

Anyway, my question is, is my dentist insane, or is the physician referral system really so pants-shittingly stupid that a referral to another specialty has to be to a specific practice, regardless of the fact that the “to” information is absolutely meaningless and the referral can be transferred to anyone within the same specialty? When I get a prescription for contacts, it’s not a prescription-for-contacts-from-Jim’s-Contacts-but-also-you-can-take-it-anywhere. It’s a prescription for contacts. Is there really not such a thing as a referral to oral surgery, without specifying any specific practice?

(Also, if that really is how it works, to any dentists out there, I strongly recommend explaining it that way from the get-go. “I’m giving you a referral to Fairfax Oral Surgery, but you can take the referral to any oral surgeon you’d like. I’m just referring you to Fairfax Oral because the referral system is brain-meltingly stupid and I have to specify something even though it means literally nothing. You can go wherever you prefer.”)

2

Giving her the benefit of the doubt, she most likely did that to make it possible for you to go to an oral surgeon in your new location without all the hassle and expense of first going to a general dentist in the new location to get a referral to the surgeon. Specialists, especially surgical specialists, don’t often take patients until a primary care provider identifies that specialty care is needed-turns out people aren’t always good at guessing when they need specialty care or surgical care.

She is making it possible for you to go straight to an oral surgeon instead of oral surgeon attempted appt back to general dentist visit to assess need then to oral surgeon. With referral, one visit. Without referral, three appts before you actually get to sit down in surgical chair for unspeakable agony to be visited upon you.

Why she didn’t just hand you an open-ended referral form without the specific practice named is beyond me. Lack of imagination? Form is auto filled in her computer, she doesn’t know how to customize it and she’s too embarrassed to ask a kid? Because that is how it has always been done?

Take it, smile, say thank you and then go to which ever oral surgeon you choose. They will be glad to have the referral regardless of who it is addressed to and they’ll use it to get your records and films, saving you trouble and time.

Expect that post-op pain medication will be vastly different than what you may have gotten even just a few years ago. Have acetaminophen and ibuprofen/or naproxen already waiting for you at home. Just a little tip I learned the hard way.

3

I think that the problem is that there are two different things meant by “referral” and you and your dentist are using different ones. One is “here’s what you need to have done and the name of a specialist I trust/work with”. That kind you can bring to the specialist of your choice, just like when my mechanic refers me to a particular shop that does electrical repairs, I can go to any shop that does electrical repairs and tell them what my mechanic says I need. It’s more or less written out version of when my dentist told me I needed to go to an oral surgeon for an extraction, and “here’s the contact information for the one I work with”. The other kind is what my former insurance had - I had to see my primary care provider who in turn referred me to a specialist. If I saw a different specialist or saw a specialist without a referral , my insurance didn’t cover the services. ( and that included specialists I saw regularly - if I saw a cardiologist 4x a year, I would have had to see my PCP for a referral 4x a year)

It’s really not like using a coupon issued by one restaurant at a different restaurant- it’s more like me telling you this particular refrigerator that Lowe’s sells would suit your purpose and you buying it at Home Depot.

4

Thanks, BippityBoppityBoo, for restoring my faith in the sanity of the medical profession by confirming, at least through implication, that there is such a thing as “referral to oral surgery.”

The reason that I used the coupon analogy is that what I was handed was a referral that said “Fairfax Oral Surgery” on it, with an explanation to Fairfax Oral Surgery of what my dentist thinks they need to look at. If I couldn’t buy a refrigerator without a referral from an Appliance Specialist, and my specialist handed me a piece of paper with the Lowe’s logo on it that gave me permission to buy a fridge, it wouldn’t be immediately obvious to me that I could take that to Home Depot and it would work just the same. What I’m objecting to is the implication that I ought to have realized that from the get-go.

If anyone’s had a generic referral to a medical specialty written for them, I’d appreciate confirmation. But, I’m satisfied with the responses I’ve gotten so far, so thanks to the kind Dopers who took the time to answer. :slight_smile:

5

We have a slightly similar situation here in the UK. Of course a dentist may well have an “arrangement” with a private dental hospital, but mostly they would refer you to an NHS surgeon.

A high street optician will want you to buy spectacles from them after a test, but they have to offer you the prescription so that you can take it wherever you want.

Dentists and opticians are not part of the NHS, although both do NHS work (if that makes sense).

6

That does make sense, yes, in the “you explained it well” sense if not the
“that seems like a reasonable way to do things” way. Getting your prescription for glasses/contacts works much the same in the US – most optician practices have an in-house or correlated lens shop, so they’ll try and get you to order from them without mentioning giving you your prescription. However, they’re required by law to give you your prescription if you ask for it, so I never leave the office after an exam without a copy of it in my hand. Some of them will fight you on it, but you can either shop around for a doctor that doesn’t, or just hold your ground until they give it to you, which they will always eventually do when they figure out you know your rights. They don’t want the legal headache.

Back to the referral thing, I actually don’t mind if the system does require a referral to a specific practice that can then be taken anywhere. I mean, it’s dumb, but it works. I just ask that it be explained that way from the outset, so that the patient knows they aren’t locked in to one single option.

7

It can be a frustrating experience. When I needed a fistula placed for dialysis, my nephrologist referred me to a specific vascular surgeon’s office. I didn’t know any better, so that’s where I went.
Unfortunately, I had issues with the vascular surgeon’s office. They liked to do some of the medical procedures in their offices. My insurance only paid for medical procedures completed in hospital. They dragged their feet at having to set up hospital time (“I’m sure you’re insurance will pay if you just talk to them!” Already did, they won’t. “Our surgeons prefer using our staff in office, though.” Bummer), and I flat out just did not like any person I dealt with at the surgeon’s office.
When I was on dialysis, it was not uncommon to need fistulagrams. They kept automatically setting up these procedures with that same surgeon’s office. It was extremely difficult to get them to grasp I would not go there. I was scolded for wanting to go elsewhere. I was told they could not “guarantee” the results if I went anywhere else. I was just being difficult, I needed to do what they said.
It came down to threatening to move everything to another nephrologist / dialysis clinic before they understood I was not joking.

8

Good job advocating for yourself! As a medical professional I wish more people did.

Also, good on you for sharing your successful experience so others might know how to do the same self-advocacy.