The Referral Paradox

As a primary care nurse practitioner (NP), a referral to a specialist is sometimes necessary. When a patient presents with a complaint outside of our scope of care or when a procedure we do not perform is required, a referral to a specialist is necessary. However, the referral process is fraught with problems. These include over-referring, low patient completion rate, and the lack of effective communication between the specialist and primary care provider (PCP). The referral may be unnecessary, thus wasting the patient’s time and health care dollars. Worse, referrals may lead to patient harm, such as unnecessary tests, procedures, and surgeries.