Primary care providers play an important role in identifying patients who may need specialized hematology care.
Hematologist Marcel Devetten, MD, offers guidance on when to refer patients and how to collaborate effectively for optimal patient outcomes.
Common referral triggers
Blood count abnormalities are the most frequent reason primary care providers refer patients to the benign hematology, according to Dr. Devetten. These include:
- Elevated or decreased white blood cells.
- Platelet abnormalities.
- Abnormal hemoglobin levels.
Coagulation abnormalities are also commonly referred, though frequently on an inpatient basis.
“A lot of patients seen in benign hematology consultation come for diagnostic purposes,” Dr. Devetten says. “They have symptoms in many cases, and in almost all cases, at least some evidence of an underlying blood abnormality.”
Many patients are what Dr. Devetten calls “puzzle patients” after primary care physicians have already ruled out common causes such as iron or vitamin B12 deficiency.
“Sometimes patients are referred for a final diagnosis and management of that diagnosis, and sometimes simply to feel reassured that there is no underlying malignant process happening,” he says.
Leveraging eConsult for efficiency
For providers within the Nebraska Medicine EPIC system, Dr. Devetten strongly recommends using eConsult when uncertain about next steps.
“If you have a patient with some abnormalities and you’re not quite sure what to do next, or if this patient should even be seen, it’s a very smart and fast way to get some essential information,” he says.
This approach may save patients from unnecessary visits or ensure appropriate testing is completed before consultation, streamlining the diagnostic process.
What sets Nebraska Medicine apart
Nebraska Medicine is at the forefront of cellular therapy and gene therapy for benign hematologic conditions.
“As a center that has used all of these treatment modalities for patients with malignant diseases, we have a lot of experience,” Dr. Devetten says. This expertise translates into access to clinical trials and FDA-approved treatments that might not be available elsewhere.
Additionally, genetic testing capabilities have expanded diagnostic precision.
“In some cases, we now have access to genetic testing that allows us to establish a definitive diagnosis in patients who in the past have been mystery diagnoses,” Dr. Devetten says.
Nebraska Medicine also offers the only comprehensive programs in the state for adults with sickle cell disease and hemophilia.
“Hemophilia treatment has evolved enormously over the last couple of years, and we offer many new treatment modality options,” Dr. Devetten says.
Urgent vs. routine referrals
Nebraska Medicine’s referral team is trained to triage patients appropriately, with most consultations scheduled within four to six weeks.
However, the team recognizes situations requiring more urgent evaluation.
“If you think there is an urgent situation, please talk to one of us,” he says. “Sometimes that information gets lost when you simply enter it in the medical record, and more details that truly indicate urgency come out in a provider-to-provider conversation.”
Both Dr. Devetten and hematologist Alex Nester, MD, are available by phone or email to help with guidance on whether a patient requires urgent evaluation.
Collaborative long-term management
Once a diagnosis is established, many patients can be effectively co-managed by their primary care providers.
“Primary management by primary care is a very good option for those patients, because in most instances, it involves some regular blood checks, and patients usually see their primary care doctor regularly anyway,” Dr. Devetten says.
The hematology team communicates clearly about what tests are needed, their frequency and which parameters should prompt a return visit to the specialist.
Communication and follow-up
All initial consultation notes are sent to referring physicians, whether within or outside the EPIC system. Dr. Devetten also shares follow-up notes when possible, though conversations between visits may occur.
“In case of questions, just ask,” he reiterates. “We have case managers who are available not just to the patients, but also to their local care teams.”
His final advice to primary care providers is simple: “We’re always happy to see your patients, and if you’re not immediately clear as to what the urgency of the evaluation should be, ask our referral team to assess it, or simply ask one of us.”
If you want to meet a member of our benign hematology team, email physicianoutreach@nebraskamed.com or call 402.559.5600.