With rapidly evolving diagnostic and treatment options, the world of equine veterinary medicine has more choices than ever before. While with time and experience many treatments and conditions become familiar, other conditions will still arise that require a second opinion, or that require expertise that may be beyond that of the attending veterinarian. The Code of Ethics of the American Veterinary Medical Association, Article VI(c) notes, “When appropriate, attending veterinarians are encouraged to seek assistance in the form of consultations and/or referrals.” In addition, many equine clients are interested in referrals to specialty hospitals and appreciate additional diagnostic and therapeutic options. Thus, it’s important to establish a relationship with one or more referral facilities in the veterinarian’s practice area. Getting to Know You It’s a good idea to get to know veterinarians who work at the facilities to which you may refer clients. Knowing the veterinarians at the referral facility (or facilities) helps you guide clients and ease concerns about the expertise offered. Interceding on a client’s behalf helps assure them that you will remain involved in their horse’s care, and that you have confidence in the referral facility. If there are multiple facilities, knowing about them will also help clients choose options with respect to cost, distance, specialties and services offered. How to Refer It is important for the referring veterinarian to create reasonable expectations for the client and their visit to the referral hospital. The client should be assured that the horse is being sent to a place that the veterinarian trusts and is staffed with people that can help both the client and the horse. Reassuring the client can help relieve anxiety. In some cases, such as referral for evaluation of colic, it may be important to simply get the horse to the referral center as quickly as possible, even if it means foregoing some diagnostic procedures (e.g., abdominocentesis). It is always important to contact the referral center to see what, if any, procedures they would like you to perform, to give them relevant information about the case you are sending, and to advise them of any medications that have been given or devices that you have placed (e.g., indwelling catheter or nasogastric tube). Work with the Referral Center The referral hospital’s job is to provide care to the referred animal and client, not to try to gain new clients. Referring veterinarians should expect, but ultimately have to trust, that the client and horse will be returning to the referring veterinarian’s care. The primary job of the referral center—other than providing care for the horse—should be to support the referring veterinarian, and not to compete with him or her. While a referral center should certainly be considered as a resource to help horses and clients, working with a referral center also provides the referring veterinarian with opportunities. For example, referral centers are often a good source of continuing education for the referring veterinarian, either through programs put on by the center, or through interactions involving case management and discussion, radiographic interpretation or watching implementation of new technologies, for example. In addition, working in tandem with a referral center offers the referring veterinarian the opportunity to stay involved with difficult cases. Clients appreciate the dedication shown by a referring veterinarian when he or she obtains updates on cases and takes the time to explain what’s going on with the horse that has been referred. Good communication is critical between the referring veterinarian and the referral center. For example, referring veterinarians should make the referral center aware of their preferred method of communication. Does the referring veterinarian prefer text messages or phone calls, or is a discharge report to add to the client record sufficient? What about copies of laboratory results or imaging studies? Communication issues can also arise between clients and trainers. Knowing what’s expected in communications makes for good relationships for everyone. Create Reasonable Expectations When referring, it’s never a good idea to be too specific with recommendations. If a client is led to believe that a particular procedure will be done, they may expect it and not be happy unless they receive it, even if the horse doesn’t need it. Unreasonable expectations can lead to awkward interactions between the referred client and the referral center, and even unnecessary expenses. When what’s expected diverges from what’s indicated, needless conflict can occur between the client, the referring veterinarian and the referral center. In that same vein, clients may appreciate information that the referring veterinarian can provide about estimated costs. Referral hospitals should be more than happy to discuss anticipated costs with the referring veterinarian so that he or she can inform the client. As an alternative, the veterinarian should encourage the horse owner to contact the referral center directly so as to avoid financial surprises. Similarly, referral centers may appreciate information about the client, for example, if they may have financial limitations. Team Effort Referrals should be a team effort between the referring veterinarian and the referral center. Good communication between the referring veterinarian and the referral center is critical for a satisfactory outcome. Referring veterinarians provide the referral center with information about the horse being referred, but they can also help explain diagnoses, treatments and prognoses to the client. Being able to refer is a good and important option in some circumstances, and it’s to everyone’s benefit to work on making it as collaborative as possible. Clients appreciate the option of referral, and a successful outcome from a referred case only reinforces the client’s confidence in the referring veterinarian. Dr. David W. Ramey is a Southern California equine practitioner who specializes in the care and treatment of pleasure horses. His website is www.doctorramey.com. Originally published in the March 2017 issue of Veterinary Practice News. Did you enjoy this article? Then subscribe today!
