A referral is the correct choice for a physician when a patient’s condition requires care that the attending physician cannot provide—perhaps because of a lack of proper facilities, because it is an area in which the physician lacks sufficient training, or because the physician does not choose to practice medicine in that area. By a proper referral, the original physician may shift the responsibility for the patient’s general care or refer the patient only for specialty treatment. In either case, the physician who accepts the referral accepts responsibility for care of the patient.

A physician may refer a patient for specialty care without transferring all responsibility for care. For example, a pediatrician may refer a patient to an otorhinolaryngologist for evaluation and insertion of tympanotomy tubes. This referral is necessary if the pediatrician lacks the training and surgical privileges necessary to provide the needed service. The referring pediatrician could remain the primary physician for the child’s preventive care and for other acute problems.

After the surgery and necessary postoperative care, the otorhinolaryngologist sends the child back to the referring pediatrician. However the responsibility for the patient’s future care is allocated, it is critical that the physicians involved understand their continuing areas of responsibility. The pediatrician should not assume that the otorhinolaryngologist will provide general medical care to the child; the otorhinolaryngologist should not assume that the pediatrician can manage postoperative complications. Both physicians must take responsibility for the care of the whole patient, with each concentrating on his or her appropriate area of expertise.

The referring physician has a limited duty to ensure the competence of the receiving physician. This is primarily a duty to determine if the physician provides the type of care the patient requires. If the referring physician has reason to believe that the receiving physician is incompetent, there may be liability for negligently selecting the receiving physician. This is a problem in MCOs that dictate the panel of referral physicians. While the primary physician may have no control over the referral, the court may find that there is still a duty to not refer to a physician who is known to be incompetent. If there are questions about the appropriateness of the referral, the referring physician should follow the patient’s progress until he or she is confident that the patient is receiving appropriate care.