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Thanks for your reply to my previous question. Our primary care physician says our child should do what he advises. That's fine with us if we can be sure this is the correct recommendation.

I contacted a pediatric endocrinologist, but he doesn't see new patients without a referral. Our PCP says no further evaluation is necessary, just do what he recommends. What do you suggest?


Any doctor should be willing to refer a case, if you approach the problem politely, positively, and assertively. Perhaps the doctor is looking at the problem entirely differently than you are. Schedule a half-hour appointment to discuss the situation from the doctor's viewpoint, and see if you might be misunderstanding what he is (or is not) advising. You can always re-ask the doctor for a referral. Plan to show him a copy of your previous question to the Diabetes Team, and the Diabetes Team's reply, and explain you're not questioning his ability, but want a second opinion. (By the way, most "second opinions" agree with the first opinion.)

Other things you can consider doing:

  • Talk to the doctor's nurse about whether there's a way to politely request a referral without creating a hassle. They know their docs better than anyone else, and might know a way to get the referral.

  • If the PCP is part of an HMO, there's frequently a financial disincentive to refer: you'll probably have to talk with the HMO's patient advocate (sometimes called a Case Manager) to get any action; find them by calling the HMO's customer service department. If nothing can be arranged through the patient advocate, speak to the Medical Director of the HMO.

Finally, if you still feel you need a referral, and you're getting nowhere, show the doctor a printout of your previous Diabetes Team question, and the Diabetes Team answer, and ask the doctor to review the document, initial it, and to file a copy in your child's chart. It would be even better if you wrote out this request, and also requested that the doctor file a copy of your request in your child's chart. (Of course, keep a copy of your letter, and the Diabetes Team question).

If the doctor hasn't seen the direction you're heading, make it clear: you want a referral, or:

  1. You'll change doctors, or
  2. You'll report his refusal to refer to the State Licensing Board, or
  3. You'll talk to your lawyer.

Then, if nothing happens, you can do one of the three.


Original posting 16 Feb 97


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