QUESTION:  Are there any guidelines or strategies for making referrals from my practice?

ANSWER:  In your capacity as a doctor of chiropractic the need and opportunity to provide patients with a wide variety of referrals will regularly arise.  It is important to maintain patient confidence and to also be confident of continued high quality care, that you be familiar with and have complete confidence in any individual provider, facility or organization to which you refer any patient.  You will want to develop a list of preferred non-chiropractic (as well as chiropractic) colleagues to whom you feel comfortable making a referral.  This will take time and some effort.

Your list of chiropractic colleagues to whom you might refer a patient should be built on chiropractic providers who have a focus or special skills that might be required from time to time, and not best provided by you or in your clinic.  Also, referrals to general practitioners in other areas for patients who move or for patients' family or friends outside your geographic area are also important.  Here you may need to rely on your state or provincial organization, or the International Chiropractors Association's worldwide referral network if you do not personally know a DC in an area where a patient or potential patient has asked for a referral.  (You can call ICA at 800/423-4690 for worldwide referrals.)

When clinical findings indicate the need for the evaluation by or care from another health professional, it is helpful to the patient for you to be able to offer the names and contact information on one or more referral providers.  You will want to be confident that any patient you refer will be welcomed by those providers, dealt with promptly with dignity and competence, and that any provider to whom you make a referral will respect the patients' choice of chiropractic care and work with you on a concurrent basis.  To secure this goal, personal relationships with other professionals are essential.  You must meet these practitioners, know their facilities and procedures and establish a cooperative understanding that will best meet the needs of the patient.  You should have a network of general medical practitioners, medical specialties, dental providers, mental health professionals, exercise and rehabilitation professionals, laboratory and imaging facilities that you personally know are competent, ethical, efficient and most important of all, chiropractic friendly.

Your goal should, in addition to close cooperation in the care of patients you refer, also include referrals to you of patients that present in their practices that need chiropractic evaluation and/or care.  Referral ought to be a two-way street.

Concurrent care is a vitally important concept in the referral equation.  No other type of provider can provide what the chiropractor provides, regardless of whatever needs a patient may have.  Chiropractic care should never be stopped, delayed or challenged by any referral you might make.

You will also be asked from time to time about non-health care referrals.  Patient needs and situations that bring stress and tension in patients' lives come up in the course of your daily practice.  Patients are likely to ask you about everything from lawyers to realtors, and it serves them and your practice both for you to be able to direct them to people in whom you have confidence.  As a doctor, you have enormous cultural authority in your community.  You are a leader in ways you might not even recognize.  People look to you for help, not just in health, but in any area in which people have needs and challenges.

Your referral network will take time to develop, and you should always wait until you are sure about a referral resource before you add them to your list. 

All referrals should be based on quality, competence and ethics.  Under no circumstances should you ever seek or accept any kickback or rebate for any referral.  This is unethical, bad business and it is against the law.

Service to the patient should, as in everything you do in your practice, always be your goal.  You can build and support patient confidence by being able to help them where needs arise for care or other kinds of help, outside what you can provide in your clinic.