Schaffer W A, Holloman F C
Ann Intern Med. 1985 Oct;103(4):600-5. doi: 10.7326/0003-4819-103-4-600.
The traditional exchange of medical expertise between physicians for patient benefit has been accomplished by referral. Physicians have traditionally decided when and to whom to refer patients. Health care "systems" now dominate medical practice, and their formats can alter spontaneous collegial interaction in referral. Institutional programs now pursue patient referrals as part of a marketing strategy to attract new patients who then become attached to the institution, rather than to a physician. Referral behavior can affect a physician's personal income in prepaid insurance programs where referrals are discouraged. The referring physician may bear legal liability for actions of the consultant. New practice arrangements and affiliations may place physicians in financial conflict-of-interest situations, challenge ethical commitments, and add new moral responsibility.
传统上，医生之间为了患者利益而进行的医学专业知识交流是通过转诊来实现的。传统上，医生决定何时以及将患者转诊给谁。如今，医疗保健“系统”主导着医疗实践，其形式可能会改变转诊过程中自发的同行间互动。机构项目现在将患者转诊作为一种营销策略的一部分，以吸引新患者，这些新患者随后会依附于该机构，而不是某位医生。在不鼓励转诊的预付保险项目中，转诊行为可能会影响医生的个人收入。转诊医生可能要为会诊医生的行为承担法律责任。新的执业安排和附属关系可能会使医生陷入经济利益冲突的境地，挑战道德承诺，并增加新的道德责任。
