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An Honest Consult: Know When to Refer


Knowing when to refer a patient can be the difference between positive and negative outcomes, but can you trust yourself to refer when needed?

Patients are asked to have trust in their physicians, but can physicians trust themselves to refer when they don’t have the expertise or tools to give the best care?

The answer is complicated, and sometimes includes a hard look in the mirror.

Interpreting a well-known saying, Randolph Waldman, M.D., facial plastic surgeon, Lexington, Ky., says, “If you only have one thing that you do, and it's a hammer then everything looks like a nail.”

He urges physicians to take stock of their expertise and experience before accepting a case, because if you’re a hammer, you have no business with a screw.

The American Academy of Cosmetic Surgery (AACS) advises patients that not every physician may be right for every procedure.

“Keep in mind that physicians specialize in different areas of cosmetic surgery. Most are not experts in every area. The surgeon who did a fantastic facelift on a friend may not be the most experienced to perform breast augmentation.”

Dr. Waldman explains that just because you can do a procedure, it doesn’t always mean you should.

For example, “We don't do ptosis surgery every day,” he says. “We have the skill level to do it. The people that do five of those a day are always going to do it better than I do.”

If he doesn’t do a procedure often, he will refer a patient to a physician who does.

“I don't think that anyone should do an occasional procedure just because they have plastic surgeon behind their name,” he says. “We understand the anatomy, but we tend to refer to people with even more expertise, because they do five a day, and we may do five a year.”

He urges those in the industry to think of their patients as family, then decide if you would be the first choice to do the procedure. If not, refer.

“I think you [should] consider every patient as if they are your spouse or your children and try to determine who you would have treat those people,” he says. “If you're not the person that can gives that type of treatment, then you really need to think long and hard about sending them to somebody that can.”

As for money and ego, neither should ever be part of the equation, says Dr. Waldman.

“In spite of being able to get $3 or $4,000 from the ptosis repair, I refer my ptosis surgery to someone outside our clinic, an eye plastic surgeon,” he says. “I choose not to do it because there are people that do it better than me. Anything more becomes money and ego and those are the two things that will drag anybody down.”

Next: First Do No Harm

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