Most patients that come to a specialty hospital like Iowa State University come on referral from their GP (general practitioner, or "primary veterinarian"). One piece I have been able to take away from a number of my rotations is how the GP can really be a major part of the referral (specialty) team.
GP's can perform many of the initial case workup, including general bloodwork, urinalysis and culture (urine tests), radiographs (x-rays), infectious disease testing, drug trials, and other items relevant to a particular set of symptoms. Then, if necessary, patients can be referred to a specialty hospital with all of their current results and a detailed medical history. One of my favorite pieces of working in a specialty hospital is digging into referring veterinarian's medical records for my day's appointments. I get so excited trying to puzzle out where the GP was going and begin thinking about what we at a specialty hospital can offer -ultrasound, specialty surgery, scoping (for example, bronchoscopy), computed tomography (CT), or magnetic resonance imaging (MRI).
On my current clinical rotation, Dermatology Service, our clinician (the faculty veterinarian over-sighting us students) does a great job of detailing what part of the work can be carried out by a GP before and after referral to a specialty hospital. For example, a patient may come to us for a deep ear cleaning under anesthesia, complicated case workup, or CO2 laser surgery, but the follow-up prescriptions, bloodwork rechecks, and bandage changes can usually be completed by most GP's. I really love how this clinician does a great job of showing us the potential roles of each team member, which will only make us better doctors regardless of the field we enter.
One neat case in particular presented with clinical signs (symptoms) that affected his movements. This patient was worked up by those investigating neurology (brain and nerves), infectious diseases, internal medicine, and many other paths. He then came to the Dermatology Service, and, it turned out, he had incredibly infected ears. The ear canals are connected to the vestibular system (what manages balance), and severe ear infections can affect this system. We anesthetized the patient,and used special fluids attached to a scope inserted into his ears to flush out considerable debris, wax, pus, and some blood. The patient's ears were very irritated from all that nastiness down there, so his ear canals were nearly closed shut from inflammation (swelling). He was given many medications to help his ears recover, and he had already begun looking better the next day! From here, the specialty team and his GP can work together to help him maintain great ear health!