Today, referrals are a daily part of any primary care practitioner’s career. But when I got out of school in 1979, things were much different than they are now. For example, when you referred out a cataract, you never saw that patient (nor his family) ever again—the ophthalmologist swiped them. Why? Because if these patients kept coming to you, their eyes would slowly melt into hair gel, of course.

Back then, I called one of my esteemed colleagues to ask him where I should send my cataract referrals. He said, “I recommend you use Dr. Mugglumps. He is a fantastic cataract surgeon and also a horse’s ass, so your patients will always want to come back to you.”

My colleague was so-ooo right. The surgeon did wonderful work, and I never lost a patient in any referral to the jerk.

Over time, I learned the referral ropes, met and intensely courted a wonderful, capable surgeon, and we’ve had a lovely referral/comanagement flow for nearly 30 years. This is the next thing to love in eye care. Not one patient’s eye has melted into hair gel.

At meetings, we’re told we should start referring to our fellow optometrists. Well, I do indeed refer to optometrists because I don’t really enjoy a couple of the staples of our profession: low vision and vision therapy. I am crappy at both and, if it will help the patient, he’s outta here. Hey, VT and LV specialties are not for the faint of heart! And the patients love me for doing what’s right for them. How do I know this? That’s what they tell me when they call me to gripe about why their insurance would not pay for VT and why their magnifiers cost $600, and they still prefer the one they got at the hobby shop. I just empathize.

Periodically, a fellow optometrist determines that it would be sensible to create a “referral center”—a place where the lion lies down with the lamb, the O.D. frolics with the ophthalmologist, and all is right with the world. To me, this makes great sense for the patients, for the health care system at large, and for all docs involved. And, have you noticed that making sense dooms all good health delivery ideas?

I, and I presume most of my colleagues, just seem unable to drop our favorite ophthalmologist for a new optometricentric doctor conglomerate, no matter how sensible it may be to do so. Remember, our relationship with the surgeon we love is close to real love! To send him or her away would be like me telling my wife that I still love her, but I’m running away with Roseanne.

(OK, that’s not a good example because, I mean, Roseanne’s rich and lives in Hawaii. Someone give her my number.)

So, we stay with our surgeon. We defend him. He brags (at least to us) about how awesome “we” are as a team. When a patient with something weird comes in, he calls and tells you, “Yes, that was weird,” instead of acting like optometrists are stupid because you couldn’t figure out that it was all due to that mosquito bite the patient got 50 years ago in Guam. 

Referrals should be genteel and easy. Refer to other optometrists as often as you can. Have trust in the doctors you choose. Make sure they know what they’re doing and that they have your back. Stick with your favorite surgeon through the inevitable bumps in the road, but an occasional fling with Roseanne is OK, too.

Did I mention she lives in Hawaii?