Desirable Characteristics of Consulting Cardiologists for Sustained Referrals by Primary Care Physicians


  • Phillip Ribeiro University of Nevada SOM Department of Internal Medicine
  • Swetal Patel University of Nevada SOM Department of Internal Medicine
  • Krystal Carlos University of Toledo Department of Emergency Medicine
  • Sumit Sehgal University of Nevada SOM Department of Internal Medicine
  • Ramdas Pai Loma Linda University Medical Center Department of Cardiology
  • Paulo Ribeiro Arkansas Heart Hospital Department of Cardiology



termination, referrals, consultants, bedside manner, patient encounter, physician feedback


Accountable care organization and high quality affordable patient care requires impeccable team work between primary and specialist care physicians. Limited data exists on evaluation of factors that lead to termination of referrals between primary care physicians and cardiologists.  Using an 11 point questionnaire of potential factors for cause of termination of referrals to cardiologists, 103 primary care providers were interviewed. Out of 103 primary care providers interviewed in Little Rock, Arkansas and Chicago, Illinois, 84 providers were practicing in the city limits and 19 in the rural areas. The most important factors that result in termination of referrals between primary care physicians and cardiologists include cardiologist's bedside manners as perceived by the patient, poor feedback to the primary care provider from the cardiologist, and the patients not getting their questions fully answered by the cardiologist during the visit.


Murphy SL, Xu JQ, Kochanek KD. 2013. Deaths: Final data for 2010. Natl Vital Stat Rep. 61:4.

Heidenreich PA, Trogdon JG, Khavjou OA, et al. 2011. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation. 123:933-44.

Barnett ML, Song Z, Landon B. 2012. Trends in Physician Referrals in the United States, 1999-2000. Arch Intern Med. 172. 2:163-70.

Chan BT, Austin PC. 2003. Patient, physician, and community factors affecting referrals to specialists in Ontario, Canada: a population-based, multi-level modeling approach.

Forrest CB, Glade GB, Baker AE, Bocian A, von Schrader S, Starfield B. 2000. Coordination of specialty referrals and physician satisfaction with referral care. 154. 5:499-506.

Segal J. 2014. The Right Way to Fight Bad Online Reviews. Medscape Business of Medicine. Retrieved from:

Thorsen O1, Hartveit M, Baerheim A. 2012. General practitioners' reflections on referring: an asymmetric or non-dialogical process?. Scandinavian journal of primary health care. Dec;30(4):241-6.

Gröber-Grätz D et al. 2011. Which criteria affect the cooperation between general practitioners and specialists in ambulatory care? A qualitative study about general practitioners' perception. Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen. 105(6):446-51.

Shewan LG, Coats AJS, Henein M. Requirements for ethical publishing in biomedical journals. International Cardiovascular Forum Journal 2015;2:2 DOI: 10.17987/icfj.v2i1.4






Original Article