The lifeblood of a quality podiatry practice is a steady and diverse physician referral base. No podiatrist would argue that point. However, there is a flipside to the axiom that all referrals are a good thing. I’m thinking about the “referral traps” I have experienced over the past 27 years as a small town podiatrist. I’m the only full-time podiatrist in my community so I’m usually the podiatry referral of choice for the in my area. Most of the primary care physicians and nurse practitioners call or send an introductory letter so I know why they sent the patient. The really good ones send a short history with the patient’s current illness and medications. All things considered, I wouldn’t trade most of my referring doctors for anything, but there have been some that I call “referral traps.” My first experience with a referral trap was when a family practice physician moved into town about 20 years ago. He told me he had a good referral relationship with a podiatrist in the town he just moved from and wanted me to be his guy in our community. He also let me know he liked to assist with any surgery. That sounded like a good plan to me and I welcomed his first referrals. The first referral was a young woman who had sprained her ankle. He called and said she was on her way to my office and probably needed surgery. The woman came to my office in a wheelchair. She was zonked. I could barely wake her up to tell me what had happened. The referring doc had given her 75 mg of Demerol and 50 mg of Visteril, IM. I asked why he did that. He explained that since we were taking her to surgery, she might as well be prepared. Her sprain was minor. It was a grade one inversion injury and did not require surgery. I put an Ace wrap on it and gave her family instructions for rest, ice, compression and elevation. A week later, she was walking just fine, although she was a much different person without all the sedation. The referring doc sent me a string of patients with similar situations. Over that first year, there were a few legitimate surgical cases. I let him assist and he was so eager to help, he would practically take over the operation. Thankfully, he had a tendency to faint when he saw blood. When he was really getting on my nerves, I would give the anesthesiologist a signal to let the cuff down. The field would become red and the good doc would hit the floor. I then reinflated the cuff and finished the case. The OR nurses were kind enough to keep a pile of pillows in one corner where they could direct the doc so he didn’t bash his brains out when he fell. I learned from several other surgeons that this doctor was doing the same thing with them. His style of practice was dangerous to the patient and likely to land us in court. We went to the hospital executive committee and had his privileges severely curtailed. He began sending his patients out of town for specialty care. Not all referral traps are primary care physicians. A few years ago, a young orthopedic surgeon called. We had a pleasant visit and he asked if I could see some of his patients for podiatric consultation. I thought I had died and gone to heaven. Orthopods are never this friendly. Over the next year, I frequently received referrals from the young orthopedist. Some were for actual foot problems but many were for hip, back or knee pain. I would examine the feet and prescribe orthotics when indicated. All seemed to be going well, maybe a little too well. The patients began coming in telling me the orthopedist had told them I could work miracles and podiatry could solve all of their musculoskeletal problems. Of course, podiatry couldn’t solve all those problems and I had a lot of angry patients to deal with. I was about to have a talk with the young orthopod and suggest we podiatrists were just as dumb as orthopedists. He spared me the awkward lecture by announcing he was moving away. I’ll take my nasty-tempered skeptical local orthopedists any day over one who likes podiatry too much. I value my referring physicians and make an effort to give their patients the care they expect. I always send a referral note and thank them for letting me help with their patients. I cultivate my referral base like a delicate rose garden. I know the difference between a rose and a weed. Dr. McCord is a Diplomate with the American Board of Podiatric Surgery. He practices at the Centralia Medical Center in Centalia, Wash.
