When in Doubt … How to Handle the Referral Process

Some patients will try to argue with their naturopathic physician to provide services the ND is not comfortable providing. However, while patients do have the right be informed of their healthcare treatment and a right to refuse healthcare treatment, they do not have the right to demand treatment.

When these situations arise, the dilemma for the healthcare provider to provide particular services may include a conflict between a business decision and a clinical decision, especially if the procedure falls within naturopathic medicine but outside their everyday experience or comfort level. The ND may start weighing the impact the decision will have on their practice (loss of perhaps not only that patient but also their family members and potential negative social media comments) and a desire to help the patient. However, if an unexpected outcome occurs, the result could be devastating.

In these situations, remember it is natural to be empathic and want to help the patient. The decision about whether to proceed can be gut-wrenching. As an ND, you have made a recommendation that you feel is in the patient’s best interests. The patient has their viewpoint and the right to refuse the referral. Although the patient may not agree, you are acting in their best interest. It is imperative in these situations not to compromise your good judgment.

When, or if, an unexpected outcome arises, the patient/family will forget your hesitancy and recommendation to seek treatment from another source. If you document your recommendations for referral and then continue providing the demanded service, you may be damaging the ability to defend your actions. Just imagine a plaintiff attorney asking why you proceeded when you clearly had reservations.

It is best to advise the patient you are not the best person to perform the service. Others who provide the service on a routine basis are better equipped. You are not admitting your inability but that another provider is more skilled and knowledgeable with that type of service. Here are a few additional tips:

  • Document your discussion with the patient thoroughly
  • If the patient agrees to the referral, follow the protocols for an effective and timely referral
  • If the patient refuses the referral, have the patient sign an informed refusal form once you have verbally reviewed the risks, benefits and alternatives of not proceeding with the recommended referral
  • Determine if the situation and patient’s behavior is critical enough to warrant dismissing the patient from your practice
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