Patients' return to referring physicians and its relation to their infertility duration

Objective: To determine if length of patient-reported infertility prior to referral to a specialist is related to the likelihood that the patient will return to the referring physician for obstetrical care. Methods: A review of our medical record database identified 430 consecutive pregnant patients, discharged between January 1, 2003, and March 1, 2004. The name of the referring and discharge obstetrician(s), duration of infertility, prior use of clomiphene citrate, and number of previous clomiphene treatment cycles were recorded. Results: Of the 430 patients, 305 (71%) had information about the referring and discharge obstetrician(s) and complete records regarding prior treatment. Median duration of infertility was 1.3 years (range 0.2-12 years). Fifty-five percent (167 of 305) of patients returned to their referring physician for obstetrical care. If patients were referred prior to 6 months of treatment by the referring obstetrician, 76% (35 of 46) returned. If patients were referred after 6 months to 1 year of treatment, 67% (82 of 122) returned. If after 1-2 years, 35% (33 of 94), and after more than 2 years, 40% (10 of 25) returned to their referring physician. Overall, 25% of patients (77 of 305) patients had preliminary treatment with clomiphene citrate. If the referring physician did not give the patient clomiphene citrate, 55% (128 of 232) returned to that physician; if the patient had been given one to four clomiphene cycles, 54% (37 of 69) returned, and if given more than four cycles, 25% (2 of 8) returned. Conclusions: Although many factors may affect a patient's decision to return to the referring doctor, patient satisfaction with the referring physician may be related to timely referral to a specialist.