Make an effort to relate to orthopedists

Open doors to potentially profitable relationships

When you occasionally need to refer patients to an orthopedic specialist, perhaps you worry you have not developed enough of a relationship with the doctor to make a good referral. In particular, does the orthopedic specialist understand the work you do, and do you understand the orthopedic specialist's work? And when referring the patient, what sort of information is most important for the orthopedic specialist to get from you?

All of those concerns are important whenever a patient is being referred to a specialist, and the referral between an occupational medicine physician and an orthopedic specialist may be more difficult than normal. Part of the problem is that the two specialties do not adequately understand each other even though they often treat the same patients.

When contacted by Occupational Health Manage-ment, the American Academy of Orthopedic Surgeons (AAOS) recommended William Tipton, MD, executive vice president of the group and previously an orthopedic surgeon practicing in Sacramento, CA, for 25 years.

(Editor's note: Tipton's comments do not necessarily represent the AAOS.)

Although he has treated many patients with work-related injuries over the years, Tipton says it is not unusual for orthopedic specialists to have little direct contact with occupational medicine specialists. That lack of contact is a hindrance when the two physicians need to collaborate on a patient's care, he says.

Tipton admits he is a good example of how little the two groups have intermingled. When first asked about improving relationships between orthopedic surgeons and "occupational medicine physicians," Tipton says he did not really know what type of physician that was. When he heard an explanation about the kind of treatment provided by occupational medicine physicians and what their concerns are, Tipton says the description sounds like "physical medicine and rehabilitation" specialists with whom he has worked. He says he was unfamiliar with the term "occupational medicine."

That reaction may be similar to what you may find in your own community when making a referral to an orthopedic specialist. The referral may occur without incident, but there is a good chance the orthopedic specialist will have little idea what you do as an occupational medicine specialist, and therefore, little idea how to work with you to the patient's benefit.

Step up and say hello

So how do you improve the situation? Tipton suggests going right to the orthopedic specialists and introducing yourself.

"You need to open a dialogue with your local orthopedic surgeons, and probably with your physical medicine and rehab specialists," he suggests.

"I would encourage you attend section meetings of the orthopedic department, where you can break into that arena just to start creating a dialogue and a relationship. That's the only way to create a team approach," Tipton adds.

To get things started, he suggests approaching the head of orthopedics at your own hospital or nearby hospitals and offering to make a presentation at the next section meeting to provide an overall explanation of occupational medicine, along with examples of how the specialties can overlap. Once you make the presentation, you are likely to find the orthopedic specialists have plenty of questions and suggestions about how to work cooperatively on a patient's care. You also will have the opportunity to ask them questions about how to best work together.

And likewise, you should invite orthopedic specialists to make the same sort of presentation to your occupational medicine group, Tipton says. In both cases, the information provided is only part of the benefit. The real gain is the personal contact that will be established between the specialists.

"Any kind of collaboration in the care of a patient will work better if the doctors are not strangers the first time you start talking about the case," Tipton says. "People are going to be much more comfortable about asking questions and talking freely about what they might not know when they've had some face-to-face experience with you already."

Show off your facilities

Those ideas sound good, says George Pratt, MD, chief medical director at Omaha (NE) Works/Rehab Visions. As an occupational medicine physician, Pratt says he often worries he is not networking well enough with the orthopedic specialists to whom he refers patients. There have been no adverse incidents with patients, but he says it does seem that occupational medicine physicians and orthopedic specialists do not interact as much as they should.

"Everybody is busy trying to take care of patients, and we all say we'll do these things tomorrow, tomorrow, tomorrow," he explains. "Pretty soon it's next year, and you still haven't done it. We're all so busy that we don't find the time to go out and network with physicians like we should."

Pratt refers patients to orthopedic specialists about once a week - usually for lateral epicondylitis, compound fractures, meniscus injuries, rotator cuff injuries, and similar problems that are unlikely to heal with occupational health care and rehabilitation.

He says he likes the idea of visiting the orthopedic specialists' meeting to present an overview of occupational medicine, and he suggests that visits to individual clinics and doctors' offices would be beneficial. He plans to invite some local orthopedic specialists to visit his facility to see what his occupational medicine practice is all about.

"They might not be aware of just what an occupational health clinic can offer, what we have available to patients," he says. "They might come down and say, `Gee, it looks like Gold's Gym here. I didn't know you had all this available. 'It could result in referrals back to us after their surgery."

Once that rapport is established, you should find it easier to communicate important information when referring a patient. Tipton suggests that the most important information to provide the orthopedic specialist - other than the clinical report on the injury and treatment to date - concerns the work environment. This is an area in which the occupational medicine specialist is likely to have detailed information concerning the patient's working conditions and possibility of working limited duty.

Tipton suggests information of that type often is not passed along to the orthopedic specialists. That physician should be diligent enough to request such information from the occupational medicine physician, but that often does not happen.

"You often hear a patient say he or she has an appointment to see a consultant six months from now, and in the meantime, the patient is off work," Tipton says. "If that's not necessary, maybe we could improve his or her care by getting more of the information that the occupational medicine physician already has."