5 doctors on the referral misfires creating clinical friction in their specialty—are you guilty of any?
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Some physicians relay goals for their ED stay that are not aligned with what an ED can do for the patient... This can present a challenging situation since a patient may state their physician sent them for an MRI, and yet we do not order non-emergent MRIs.
—Laleh Gharahbaghian, MD, emergency medicine physician at Stanford
What do you wish other specialists knew about your field of medicine?
MDLinx asked five physicians what they wish others better understood about their field, and the answers may surprise you.
Emergency medicine
Laleh Gharahbaghian, MD, is an emergency medicine physician at Stanford. She argues it would be helpful if other physicians remembered that the emergency department is not the best place for treating chronic conditions or other non-emergent issues.
“Emergency medicine exists as a safety net to healthcare, but does not and cannot provide all care, with a focus being on emergent/urgent conditions. ED diagnosis and management is for emergent/urgent conditions. We are not the specialty for chronic conditions assessment and treatment, unless those conditions have emergent exacerbations that we can help alleviate,” she tells MDLinx.
“Some physicians relay goals for their ED stay that are not aligned with what an ED can do for the patient," Dr. Gharahbaghian continues. "For instance, if someone injured their knee or has back pain without any red flags to warrant emergent imaging, then we make our best judgement in diagnosis, treat the pain, apply a brace if needed, and then refer them to follow-up care. We likely will not order the advanced imaging modality (ie, MRI). This can present a challenging situation since a patient may state their physician sent them for an MRI and yet we say we do not order non-emergent MRIs.”
Psychiatry and neurology
Sarah Hon, DO, is a psychiatrist and neurologist at the University of Kansas Health System. She says it is essential that physicians help recognize symptoms of neurological disorders early so patients can be appropriately referred.
“The partnership between primary care providers and neurologists is invaluable. Early recognition of signs and symptoms of neurological disorders by those primary care providers, followed by appropriate referral of those patients to a neurologist, is key to making sure patients get the care they need. I always appreciate a brief summary of why the patient is being referred, and welcome calls to discuss cases and to suggest testing and potential treatments prior to seeing me,” she says.
Infectious disease
Dean Blumberg, MD, is Chief of Pediatric Infectious Diseases at UC Davis. He says other providers will sometimes send referrals to infectious diseases without understanding the scope of practice.
“The biggest thing is chronic fatigue syndrome. Certainly, it can be triggered by an infection, but the syndrome is not caused by active infection. And so I don't have anything to offer these patients in terms of treatment or diagnosis in that area, because they don't have an active infection by the time that they're sent to me. So I'm really not useful for them for that,” he tells MDLinx.
“If you have a patient who you think has an active infection—for example, ongoing fever and systemic inflammation—that's a patient that we can help you with. But patients who are post infectious, for the most part, we can't help with that. I wish we could, and I wish we had more resources in the community for that, but at the present time, we just don't have a setup for that,” he adds.
OB/GYN
Steven Vasilev, MD, is a gynecologic oncologist specializing in endometriosis, and founder of the Lotus Endometriosis Institute in Santa Monica, CA.
He says there are many things that are misunderstood about endometriosis diagnosis and management.
“The single most important message from endometriosis excision surgeons is: surgical visualization with histologic confirmation remains the only definitive way to diagnose endometriosis today," he tells MDLinx. No blood test, biomarker, or imaging modality can replace it. ACOG's 2026 shift toward clinical/presumptive diagnosis was specifically designed to reduce the 5- to 12-year diagnostic delay and allow earlier initiation of temporizing medical therapy, not to replace surgery as the gold standard."
Related: Could this blood test finally catch missed endometriosis cases?
Burns and other wounds
Julie Slater, MD, is Medical Director of the Burnett Burn Center at The University of Kansas Health System. She says there are a few things physicians from other fields could keep in mind when dealing with patients with burns.
“For burn surgery, you often cannot tell the extent of a burn unless you wash the affected area. You may have soot making a small burn look large, or loose skin hiding the fact that there is a large burn when the skin comes off. Please wipe down the area. Also, please, no ice on burns. It can lead to deeper injuries,” she tells MDLinx.
“For plastics wound surgery, coverage of pressure ulcers is a major surgery and recovery," Dr Slater adds. "Please work on medically optimizing and ensuring patients have social support before referring them for flap coverage. Also, please know that after surgery, they will need to spend 6-8 weeks on bedrest, most likely in a nursing facility.”
Related: Why patients with non-specific symptoms get bounced between specialists—and how to stop it