The Pediatric Diagnostic Referral Service: Filling in the Subspecialty Cracks

Abstract

In a large academic tertiary-care center with scores of pediatric specialists and subspecialists, it is hard to imagine that there is not a “consultant” available to receive all patients referred for evaluation. Many centers, large and small, have a few clinically oriented or interested physicians who are willing to see patients referred with problems not clearly related to one organ system or specialty area. Some centers have long-established mechanisms for referrals and consultations, utilizing hospital-based generalists who are heavily involved in both the inpatient and outpatient services.¹ In other centers ambulatory pediatric faculty assist resident physicians who see patients referred by other physicians or self-referred by parents seeking a second opinion. Not uncommonly children are seen by subspecialists in a “best of fit” mode, hoping that the problem corresponds to their area of expertise. If the problem does not appear to be in the realm of the subspecialist, the patient may be referred to another subspecialist or simply returned to the referring physician.