Expert: John Pilcher, MD - 5/2/2010

Question
QUESTION: Hi. I am Joyce Hall. I am writing for my husband James. See, he wants to go and see a Dr about the weight loss surgery. The lap band system.
He's had 6 back operations, 4 heart attacks, open heart surgery, multiple stents,unlcers and is diabetic. He's 63 in June.
The problem is that our Dr (primary) keeps arguing with him about it. A few months ago, the Dr said my husband wasn't fat enough. Yesterday he told us that my husband is too old.  I called the weight loss program and found out that isn't so and as far as the health problems, he'd have to be evaluated first.
So I called the Dr back and told him all this, and if we could just have the referral, we could go from there.
Now my question is: 1.Can we force his hand? Can we make the Dr give us the referral?
Thanks, I appreciate your help.

ANSWER: Mrs. Hall (Joyce),
This is potentially a really sensitive subject, but the answer is 'no,' you can't force the doctor to give you a referral.

On the other hand, you should feel proper in seeking a second opinion from another doctor on your plan who does primary care.  A second opinion is just about always a good idea in medical care if there is a disagreement about what should be done.

The surgical office may be able to point you toward a doctor who works with them regularly, so that you get a genuine separate opinion from your current physician.

Best of luck!
Dr JP

---------- FOLLOW-UP ----------

QUESTION: If we did that, would that Dr be able to give us a referral or do we just have to go back to our primary and tell him. Because if our present Dr still refuses all we can do is to find another Dr who will give us the referral. Neither of us see the point in seeing a Dr who won't help you.

ANSWER: Sorry I was not clear.  You should look in your insurance book to find a list of primary doctors on your plan.  Using that list, ask the surgical program which doctors they work with regularly.  If you choose to designate one of those other doctors as the new primary, then he/she will be able to give you the referral you require.

Best of luck!
Dr JP

---------- FOLLOW-UP ----------

QUESTION: Oh I think I get it now. Only a primary can refer him? Can his cardiologist do it?
Thank you for helping me.

Answer
Usually an insurance plan picks one doctor to be the designated "gatekeeper" for each patient.  So in other words, if the family practice doctor is designated as "primary" then the cardiologist would not be able to provide the referral.  If a different doctor is chosen as "primary doctor," then the new doctor should be able to provide a referral.

Best of luck,
Dr JP