Imagine that you received a referral from your family doctor for a second-level specialist consultation for a nagging leg pain, but by the time you got to the appointment, your arm had started to hurt as well. However, a similar but new complaint may require a return visit to the GP.
Otherwise, if you go to, for example, an endocrinologist, you would like to be consulted about several problems, you can also remain without anything. The portal tv3.lt reminds that it has already written that a woman who came to the ophthalmologist to have her eyesight checked and to get a prescription for glasses was also faced with a request to come next time with a new referral.
Consults on only one problem
Family doctors confirm that such referrals of patients from one doctor’s door to another are not new. But usually, it is not out of malice that the specialist doctor does not want to consult more than what is planned at the time – there can be various reasons for this. Consultation time, payment procedure for rendered services can limit the specialist. In addition, a doctor may specialize only in a certain narrow field.
“Such situations where it is necessary to return to the family doctor are quite common. And as a result, the patient who would like to receive the service in full, but receives it only partially, is usually affected, because the specialists solve only one problem”, says A. Astafjeva.
“It really happens that sometimes specialists do not finish the consultation, so patients need to return for a new referral. But there are also those cases when family doctors send a patient to a specialist for a single diagnosis, for example, thyroid problems to an endocrinologist. This specialist also treats diabetes, but in that case he will only examine the patient for one of these conditions, although according to his competence he is responsible for consulting on both,” Alma Astafjeva, deputy chairperson of the Lithuanian family doctors’ trade union, told tv3.lt.
She pointed out that some doctors in the same field specialize in a certain field, so a patient who has not been examined the next time can simply register with the wrong doctor.
“For example, we send to an orthopedic traumatologist, the patient registers, and it turns out that he has registered with the one who advises on surgical treatment of the knee, but does not look at the shoulder, and the person was sent precisely because of shoulder pathology. These situations, when it is necessary to return to the family doctor, are quite common. And as a result, the patient who would like to receive a detailed consultation, but receives only a partial one, is usually affected because the specialists solve only one problem,” commented the doctor.
Doctors and patients become hostages
According to the interlocutor, basically such situations are related to financing.
“Because even with one disease, one type of research is needed, and in another case, another. Specialists do not have a choice, they act as the institution instructs. Therefore, we distinguish one health problem, although the patient often has several pathologies that are solved by the same specialist. Of course, he may not have enough time to give quality advice on several problems. This is not an easily solved problem”, said A. Astafjeva.
True, she noticed that changes are already underway on the part of the Ministry of Health, as extended consultations are encouraged.
And the patient always has the expectation of receiving a detailed consultation, but currently the health system is not favorable to either the patient or the doctor himself.
VLK: the specialist must provide all assistance
When asked if there is a limit to the number of health issues that can be resolved during a consultation, the State Sickness Fund (VLK) stated that each patient’s treatment case is individual.
“In all cases, the doctor treating the patient decides on the treatment, on the number of visits and on the necessity of tests, on the prescription of medicines and medical aids to the patient,” commented Žydrūnė Baigienė, advisor of the Service Expertise and Control Department of VLK.
At the same time, she assured that the specialist should provide as much help as possible during the same visit. The specialist reminded that, in accordance with the order of the Minister of Health Protection, the visit of a patient with a referral for a specific reason is considered a consultation of a specialist doctor, when during this visit, all necessary research and treatment actions for the patient are carried out according to the competence of the specialist doctor, and written advice is given to the referring doctor.
“Thus, any medical specialist must follow a holistic principle when consulting a patient, i.e. the patient must be examined and consulted for all diseases assigned to the medical specialist’s competence, which in the case of a specific clinical situation, in the opinion of the medical specialist, may be significant in providing advice to the referring doctor regarding the patient’s diagnosis identification or selection of treatment tactics”, explained the specialist of the health insurance fund.
Therefore, with one referral, the patient must be examined comprehensively and he must not be unnecessarily sent to re-register if he has several complaints during the visit to the doctor or if the specialist doctor himself suspects another illness during the consultation.
“For example, when a patient was previously referred for a consultation with an endocrinologist for the control of diabetes treatment, and during the consultation the doctor also detects a pathology of the thyroid gland, the patient must be given the necessary assistance for further examination or treatment for another disease, even though it was not specified in the referral .
Or the patient comes to the ophthalmologist with a referral for impaired vision and the doctor, after performing the vision test for the patient, must also write a prescription for glasses if the patient needs them,” asserted Ž. Graduation
Payment encourages full assistance
According to her, when a doctor does not have the ability to solve a patient’s health problems himself, he consults with another specialist doctor about his condition.
“In such cases, a referral is issued for the consultation of another specialist doctor. After these consultations, examinations or inpatient treatment, the family doctor continues to take care of the patient’s health according to the recommendations”, commented the specialist of the health fund.
“Even last year, the payment for such larger-scale consultations of certain specialists, which lead to the formation of the longest waiting lines, increased by about 30-50 percent,” said the VLK specialist.
Ž. According to the graduate, the procedure for payment of medical specialists from the Mandatory Health Insurance Fund encourages the patient to be provided with all the necessary assistance during the first visit.
“Service prices are differentiated and depend on the tests and diagnostic actions performed on the patient (expanded and more detailed examination consultations are paid at a higher price).
In this way, institutions are encouraged to provide comprehensive consultations to patients during one visit, which reduces the need for the patient to come again, and at the same time, queues are reduced.
Even last year, the payment for such larger-scale consultations of certain specialists, which lead to the formation of the longest waiting lines, increased by about 30-50 percent,” the VLK specialist asserted.
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