Case Management, Referral, and Co-management
Decide who treats what
Case management is the discipline of deciding who treats what, when, and where. Refer for diagnostic uncertainty, red flags, findings outside your scope, studies you cannot order, and failure to respond to a reasonable trial. Urgent, same-day referral applies to suspected cauda equina syndrome, progressive neurologic deficit, suspected fracture, infection, malignancy, and vascular or cardiac presentations.
Co-management
Send a specific question, the relevant findings, and what you have already tried; ask for the report back. Close the loop by documenting that the referral occurred and what came of it. With a primary care provider, agree on who manages medication, imaging, and return-to-work status. Keep treating within your scope while the other provider addresses theirs.
Traps
Not referring out of attachment to the treatment plan. Referring without a specific question. Abandoning the patient after referral-proper termination requires notice, records, and reasonable transition. Assuming another provider's note substitutes for your own assessment.
Rule of thumb
If you would be uncomfortable defending the delay in a deposition, refer now rather than at the next visit.