Collaboration within our profession is essential for practice and positive patient outcomes… but when do you decide when to refer a patient on to a colleague?
As an early career optometrist, I graduated from University legally qualified yet horribly nervous. I felt like I was expected to know it all, and I wasn’t sure where to turn when I needed advice or an expert opinion that wasn’t available in my own practice.
I soon learnt the value of intra-professional referrals. The ‘10905’ Medicare item number is designed to give the full Medicare rebate of AU$66.90 to practitioners who have been provided a written referral from other optometrists. The referral should be at ‘arms-length’, that is, no commercial connections should exist between yourself and the person you are referring to, and the letter needs to be kept on file for two years.
It is worth introducing yourself to the clinics around you, and being aware of the services they offer – this will make it easier to give and receive appropriate referrals.
The sooner the stigma around referring to other colleagues is broken down, the sooner our patients will benefit
Grey Areas
Many optometrists feel comfortable with certain intra-professional referrals – for example, they don’t think twice about referring an advanced keratoconic patient who needs an RGP fit to a speciality contact lens practitioner… or a patient with learning difficulties but a normal binocular vision system for a visual information processing test.
However, there are cases where the lines are more blurred such as orthokeratology. Do you speak about this treatment option to all suitable patients, or do you only recommend the options offered in your practice, such as spectacles and soft contact lenses? When do you decide that a patient should be made privy to this option?
The hardest thing about intra-professional referrals, is the potential to lose a patient, or the potential to lose a dispensing sale as a result of referring the patient elsewhere. Optometry is unique in offering both a clinical and retail service, both of which are integral to our practices. We need to supplement our clinical care with retail sales, but despite this, our priority should be the patient’s welfare.
Working Up a Patient vs. Handballing a Patient
Since practicing at Lakkis Optometry and the University of Melbourne Eyecare, I have been exposed to many intra-professional referrals. We receive referrals for undiagnosed red eyes, myopia control, OCT scans, glaucoma management, OrthoK and rigid contact lens fits, from both non-therapeutic and therapeutic practitioners. We also make referrals to other optometrists for testing we do not offer, such as visual information processing tests, visual training and IPL for dry eyes. The patient appreciates being referred for more comprehensive care, and is always referred back to their original optometrist once treatment is completed.
In the referral letter, it is important to include all the tests that have already been completed as well as a brief ocular history – this differentiates a considered referral from a lazy one. This should then be followed by correspondence back to the referring optometrist, and letters between practitioners if the patient requires ongoing shared care.
Implementing Change
There is a stigma attached to ‘referrals’ to other optometrists, due to the impression that the referring optometrist has an inferior knowledge case. I believe this is an attitude that we need to leave behind because, faced with a rapidly expanding ophthalmic knowledge base and increasingly technical (yet costly) clinical equipment, no single practitioner can be an expert in all aspects of optometry.Additionally, as our population ages, effective collaborative practice will become essential for health care and positive outcomes for our patients.
The sooner the stigma around referring to other colleagues is broken down, the sooner our patients will benefit from a wider range of optometric services and discover that optometry is not just about glasses.
Katrina Yap graduated with a Bachelor of Optometry from the University of Melbourne in 2013. She practices at Lakkis Optometry and is a clinical teaching instructor at the University of Melbourne Eyecare.
