I agree with Dr. Hickner’s editorial “To refer—or not?” (J Fam Pract. 2019;68:8) that family physicians could manage about 30% of the patients they refer to specialists. Still, it’s worth noting that many referrals are motivated by the threat of unmerited malpractice suits. Until the medical liability system becomes less adversarial and unmerited suits are eliminated, all primary care doctors—not just family physicians—will continue to send patients to specialists—even when these physicians are themselves capable of treating such patients.
What might help mitigate malpractice suits? There could be benefit from oversight of health courts, which would be presided over by judges with special training in medical malpractice. Being nonadversarial, health courts would cut down on legal wrangling, settle suits, and get awards to patients quicker. They would also cut down on attorney and court fees, which account for almost half of the total amount spent on litigation. These courts wouldn’t completely eliminate unnecessary referrals to specialists, but they could help make a difference.
Edward Volpintesta, MD