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Generalists and specialists don't always speak the same language. There is a tremendous amount of trepidation on the part of specialists who are treating patients who have been referred to them. Many times the specialist is unsure what the referring physician wants him or her to do. For example, an orthopedist who is treating a patient with a knee injury is uncertain if the referring doctor wants him to confirm the diagnosis and send the patient back or take care of the problem because the referring physician does not know how to manage a collateral ligament sprain.

To eliminate this problem, many referring doctors have started using referral forms. These quick and easy forms only take a few minutes to fill out and provide a brief history of the patient's situation, a description of the relevant physical findings, important lab reports and the questions he or she wants the specialist to answer. By providing these questions, the referring doctor omits a lot of the guesswork that sometimes falls on specialists when treating a referred patient.

Specialists can return the favor. Once you have seen a referred patient, fax a short memo to the referring physician stating the diagnosis, procedures and treatment plan. Later on, you can send a full report to the referring doctor. Try to do this within a half hour of seeing the patient. If something requires immediate attention or there is a question, call the referring doctor.

Another wrinkle in generalist/specialist relations is who is responsible for talking to the patient about their findings. Most agree that the specialist should be the one to relay this information to the patient. A cardiologist can best explain a myocardial infarction than a family practitioner. Only in cases where cancer is found or the patient is not of sound mind should the generalist be the one to communicate the diagnosis.

A big problem to avoid–referring patients to another specialist without consulting with the referring doctor. The best way to rid yourself of this problem is to let the patients decide if they want to go to another doctor or speak to the referring physician first. If they choose to see the other specialist, you should send a note to the generalist stating that you gave the patient the option and they have decided to move ahead with another specialist.

Establishing referral guidelines between generalists and specialists is a good way to nip all problems in the bud. For example, the guidelines may state that the specialist must notify the referring physician within forty-eight hours after the patient's first visit, follow up with a letter and forward a summary at the end of treatment. This leaves very little room for miscommunication between the doctors.

Unfortunately, managed care has created an "us" vs. "them" mentality between specialists and generalists. It is up to the primary care physician to decide if a specialist is needed and it is up to the specialist to decide if further treatment is needed. By being respectful of referring physician's guidelines and the relationship they have with their patients, you can spare yourself from being dropped as a preferred specialist.