The next outpatient on my schedule is brand-new to our facility. I have received a referral authorising me to evaluate and treat, but with no records or indication of the problem. Our check-in process shows normal growth, vital signs, and urinalysis. The new patient form filled out by the family states "my doctor referred me" as the reason for their nephrology referral. The review of systems on the form also reveals no signs or symptoms of problems. I ask the family why they are seeing the kidney doctor, and they tell me their doctor thought it was a good idea.
This presentation makes an initial visit with a specialist less useful than it should be. Trying to identify the issue can take all my detective skills and multiple phone calls. There are things patients can do to prevent this situation:
- Know why the referral is made, even if you cannot say it in doctor-talk; "blood in the urine" tells me just as much as "hematuria"
- Get copies of relevant test results, even if your doctor says they will be sent; medical centers still work by fax machine. Assuming your records get faxed to the correct number, the paper then needs to get picked up off the machine and scanned or filed into the correct chart. Several opportunities for loss or other errors present themselves in this process. Having a copy with you may save unnecessary testing and speed up the evaluation.
- Bring a list of all medications, including vitamins, supplements, and over-the-counter drugs; better yet, bring all your medication containers.
A bit of preparation can help your specialty appointment go most efficiently. Your efforts can help avoid redundant testing and reduce medical costs. Also, never underestimate the value of making our job easier.