The family doctor treats many health disorders
Healthcare usually starts with the family doctor – we first turn to them when we feel unwell or have health problems. The family doctor assesses the patient’s condition, listens to complaints, orders necessary tests, makes a diagnosis, and applies treatment. They can diagnose and treat most common diseases and health disorders, so specialist consultations are not always needed.
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“The patient feels symptoms, and the family doctor evaluates the whole picture – medical history, test results, risk factors, and overall health status. From this, they decide whether a specialist consultation is medically necessary and which specialist could help,” says family doctor Alma Astafjeva, chairperson of the Lithuanian Family Doctors’ Professional Union.
A referral is issued only when the family doctor, after assessing the patient’s condition, determines medical indications for a specialist consultation. If the health disorder or disease can be diagnosed and treated by the family doctor and their team, specialist help is not needed.
For example, headaches do not necessarily indicate a neurological disease – they are often related to blood pressure fluctuations, stress, or other factors that the family doctor can treat. In cases of back or joint pain, conservative treatment is often applied first – medication, adjustment of physical activity, physiotherapy, or other measures. If such treatment is insufficient or more detailed examination is needed, the family doctor refers the patient to a specialist.
A specialist doctor can refer to another specialist
In certain cases, a referral can also be issued by a specialist doctor when it becomes clear during treatment that a consultation with another specialist or a specialized examination is needed.
For example, if a cardiologist treating heart rhythm disorders suspects that the cause may be related to hormonal system disorders, they can refer the patient to an endocrinologist. If an orthopedic traumatologist suspects that joint pain is caused by an inflammatory disease, the patient may be referred to a rheumatologist for consultation.
In such cases, the patient does not need to contact the family doctor again just for a referral – they can directly register with the specialist indicated in the referral.
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More opportunities to issue referrals for reimbursed services
From July 1, in all healthcare institutions contracted with the health insurance fund – both public and private – specialist doctors can issue referrals for health insurance reimbursed services during both free and paid consultations.
This means that for a person insured under compulsory health insurance, during a paid consultation, the doctor can issue a referral for continued health insurance reimbursed services if the referral is issued while providing a consultation for which the healthcare institution has a contract with the health insurance fund. Additionally, the doctor must determine that it is appropriate to provide further reimbursed services due to the patient’s health condition. The fact that a person paid for the consultation alone does not entitle them to receive a referral for reimbursed services.
The doctor notes this information in the referral, and the patient can choose a healthcare institution contracted with the health insurance fund where they wish to receive the service indicated in the referral.
“This procedure is especially relevant when a patient needs another specialist consultation or other reimbursed services after one specialist consultation. Then the path to the required service becomes shorter and simpler,” says Indrė Lyvė, advisor at the State Health Insurance Fund’s Service Reimbursement Department.
The decision regarding the referral is always made individually. In some cases, it is issued immediately; in others, it is necessary to wait for test results or evaluate treatment effectiveness. Often, a specialist consultation is not needed because the family doctor’s team provides the necessary help to the patient. A referral is not a separate service – it is a medical decision made considering the patient’s health condition and treatment needs.
