What surgeons wish GPs knew: Smoother referrals and better outcomes

Veterinary specialists and general practitioners share the same goal: better outcomes for patients and a smoother experience for clients. On this episode of Vet Watch, Shadi J. Ireifej, DVM, DACVS-SA, joins our host Christopher Lee, DVM, MPH, DACVPM, DACVM (parasitology), to discuss how veterinary general practitioners (GPs) can make referrals smoother for everyone, leading to better patient outcomes.

Throughout the episode, Ireifej advises general practitioners to educate clients about prognosis and costs, and to consider emergency referrals for cases requiring hospitalization and intensive care, the importance of timely referrals, and the potential need for repeat diagnostics.

Transcript

Christopher Lee, DVM, MPH, DACVPM, DACVM (parasitology): From your perspective, what's the ideal way for a GP? How can they, ahead of time, work up a prognosis, cost, all the questions, all the things that the clients want to know?

Shadi J. Ireifej, DVM, DACVS-SA: You certainly want, as a GP, to educate your clients, especially if you've had clients that have been with you for years or even generations of family, and they're comfortable with you, and so then, they trust your information. At the same time as a GP, you also don't necessarily want to speak out of turn or overstep any areas of medicine that maybe you're just not as clear on, especially if you know that they're going to be receiving another opinion from a specialist.

So you speak within your own experiences as a professional, which you ought to do. You speak to things that you know are factual and true, but it's also not wrong to leave things in a gray area, or say, You know what? I just don't know, but that's why I'm sending you to the specialist. They can fill in the blanks. They have more experience with hemilaminectomies than I do, or thoracotomies than I do, and so let them speak to that. I don’t want to say something out of turn, being candid like that with a client, especially a long-term client who really trusts you, that goes a long way. Right? We all have access to medical literature. There are always publications you can review or textbooks. You can always phone a friend to get more information on the case that you want to elaborate further on with a client, but also, GPs are busy, and if this is a surgical emergency, you may not have time to do a deep dive over the next week on a disease process or a surgery. So feel free to go up to where you are comfortable with your own experiences, and then leave room for the specialist to fill in the blank from there.

Lee: No, that's helpful. Moving on to when we're trying to move them fast, over to referral, such as with an emergency situation, in your experience, what are the most common misunderstandings about conditions that truly need emergency referral, and which can wait?

Ireifej: I love that question, because we see this a lot, not just in brick and mortar, but even with my telehealth company, Vetriage. I see a lot of patients that are being managed—to no one's fault; it's just a matter of experience level…as an outpatient at a general practice. When someone like me looks at the radiographs, the blood work, the patient's condition, my immediate thought is, Why isn't this patient being hospitalized and receiving intravenous treatment? So every GP, of course, is going to be different depending on how long they've been in practice and what their level of experience is, and what their style is, and client factors and pet factors, financial, but if you break it down to its foundation, there are some pets that can be managed as outpatients. There are others that really need to be hospitalized and in a 24/7 facility, being monitored and receiving intravenous therapies, all that.

So one of the biggest challenges that I see when it comes to an emergency referral is setting the client up for what's entailed with that. Your pet is not going home with you after that meeting…they need to stay there. How many days? We don't know. What are they going to do? Whatever they think is best. What's it cost? You’ve got to talk to them about it. But in general, I've seen the bill go around $1000 to $5000 or whatever. Make it where you're setting that client up, in a general sense, because they're so used to your prices as a general practitioner, and so used to to working with you on an outpatient basis, to think of leaving the pet in a facility, not just for a day, maybe multiple days, and then spending a multitude more financially for that care, you’d rather be up front and mention that to them ahead of time, prior to the referral.

It also makes the job easier for the referral center, because now the client has been prepped, albeit in a general sense, but they've been prepped for what to expect, sort of, and that's good enough. We'll take it because we're trying to admit that patient for emergency care, intensive care, an expensive estimate, days in the hospital, and prognosis discussions. It makes our job easier on the emergency and referral side if the client is set up that way too. Even though it's general, it's still very, very helpful.

You can listen to the full conversation in this week’s episode of Vet Watch!