The generalist's patient and the subspecialist.

Objective: To examine if required referring procedures from generalists to subspecialists for managed care patients affect communication between the physicians.

Background: Collaboration between generalists and subspecialists is essential for successful referrals and a satisfactory relationship between the physicians. However, breakdowns in information transfers in outpatient referrals continue to be described. Moreover, the referral process within managed care systems may be adding new elements that interfere with communication between physicians, promoting fragmentation of care.

Methods: Current referral forms or electronic approval mechanisms encourage responses for billing approval, but neglect methods to require questions from generalists and replies from the subspecialist. Other barriers to communication between physicians are discussed. Responsibilities for agencies, patients, and doctors are reviewed.

Conclusions: Insuring agencies need to provide uniform rules and educational mechanisms describing patients' timely responsibilities in the consultation process. In addition, methods need to be created to convey reasons and data for referral from generalists to subspecialists, and recommendations from subspecialists back to the generalists.