A simple rule for when to ask your doctor for a referral to a specialist

In my practice as a Houston, Texas medical malpractice attorney, I have represented many clients who knew something was wrong with their health and quickly went to their doctor. The problem arose when the doctor saw the patients over and over, but never arrived at the correct diagnosis or treatment.

Sadly, delayed treatment and diagnosis can cause life-threatening permanent injuries or even death.

This leads to the question of how long you should wait—or keep making appointments—for the same doctor to make the right diagnosis and treatment.

Doctors grapple with a similar question-- how long they should wait before making a referral to a specialist or another physician.

Referrals and consultations

Many people have an existing relationship with a primary care physician. For children, it is a pediatrician. For adults, it may be a family practice or internal medicine doctor. I would describe these types of physicians as generalists. The standard of care requires them to be highly-educated and skilled about a wide variety of medical conditions.

Pediatricians, family practice doctors, and internists are generally overseers of health care for their patients. They typically provide preventive care and routine treatment themselves. Other illnesses often fall outside their training, meaning that they need to order a consultation or refer them to other physicians with more specialized training.

A past president of the American Academy of Family Physicians recommends that doctors use the “rule of three.” It basically works like this: If the doctor cannot diagnose a patient’s condition after three appointments, it is time to seek a colleague’s opinion or refer the patient to a specialist.

Research shows that around 40% of time doctors cannot make a diagnosis of patient symptoms during a first visit, and it may take a few more visits to get more details and initial test results. That is why three visits to one doctor is a good bright for whether to continue treatment there or get to a specialist.

What you can do

The baton-passing referral/consultation process is an essential part of medicine, but published medical research reveals that it is inconsistently executed. Specialists have complained that they receive referred patients after an excessive amount of time has passed, and with too little patient information.

Being sick and not seeing light at the end of the tunnel is miserable. If you find yourself going to the same doctor over and over, but do not have a clear diagnosis or treatment plan, keep the “rule of three” in mind.

Throughout the process of receiving care, ask your doctor about the “differential diagnosis” list. When doctors are not sure what is causing a patient’s signs and symptoms, the standard of care requires them to make a list of the different potential illnesses that could be the culprit—this is call the differential diagnosis list. Doctors then use evaluations, assessments, lab work, radiology scans, and other testing to rule in or out each potential diagnosis from the list.

In numerous medical negligence lawsuits in which I have hired medical experts to explain to the judge and jury what happened, the experts have testified that the standard of care requires doctors to rule out the most dangerous, life-threatening conditions first. Unfortunately, doctors do not always do this.

During each visit, ask your doctor about the items on the differential diagnosis list and what conditions have been ruled out, or eliminated, from the list.

If you get to a third visit, and the diagnosis and treatment do not seem anywhere closer, talk to your doctor about what specialist or specialists might be helpful for you to see. Ask for specific recommendations, and see if your doctor’s office can set up the appointment directly. This may help you avoid a long wait. Be sure to get a copy of your medical records from your doctor before going to the specialist appointment.

We are here to help

If you or someone you care for has been seriously injured by poor physician care, including the failure to make a timely diagnosis, treatment, or referral/consultation to a specialist, then the experienced medical malpractice lawyers at Painter Law Firm, in Houston, Texas, are here to help. Call us at 281-580-8800 for a free consultation about your potential case.


Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He files medical negligence and wrongful death lawsuits against hospitals, doctors, surgeons, anesthesiologists, laboratories, and pharmacies on behalf of patients and their families.

Robert Painter
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Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.