American College of Physicians: Internal Medicine — Doctors for Adults ®


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From the June 1998 ACP Observer, copyright 1998 by the American College of Physicians.

Many Americans fear they will not get a referral when needed

Although most Americans trust that their primary care doctors will refer them to specialists when necessary, a substantial minority—16%—are concerned that their doctor may not give them a referral, according to a study by the Center for Studying Health System Change.

That mistrust is even greater in certain communities. In Miami, for example, 22% of patients surveyed said that they feared their doctor might not refer them to a specialist when needed. Nearly a third of primary care physicians surveyed in Miami also reported that they "cannot always or almost always obtain referrals to high quality specialists with medically necessary." Across the country, the percentage of primary care physicians reporting this trouble was closer to 20%.

In general, there was a high correlation between patients' and physicians' perspectives on access to specialists. For instance, both patients and doctors in Indianapolis, Ind., reported less difficulty (13% of patients and 6% of doctors), as did those in Boston, Seattle and Syracuse, N.Y. Aside from Miami, the regions where both patients and doctors reported higher fears than the national average included Orange County, Calif., and Phoenix.

Diabetes on the rise

The number of Americans with diabetes is now higher than ever. According to the CDC, 15.7 million people in the United States—6% of the population—have the disease. It is the fourth leading cause of death by disease in the country.

Hardest hit by the steady increase in numbers of diabetics reported in this country are black Americans. The CDC reported last fall that the prevalence of diabetes among blacks rose 33% from 1980 to 1994, compared to 11% for white Americans. Native Americans also suffer disproportionately from the disease.

More than 18% of Americans over age 65 have diabetes, while 8.2% of Americans 20 and over have the disease.

The CDC estimates that nearly a third of all cases of diabetes remain undiagnosed. Last summer, the American Diabetes Association recommended that all adults age 45 and above be screened for diabetes every three years if no other risk factors exist. Screening should begin earlier and continue more frequently if there are other risk factors.

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