Pcp, what would you do?your pt.has a gyn problem.you offer to examine & treat it but she insists on a referral to a gyn covered by her hmo.

Refer: That's fine. It's up to her. Maybe she's more comfortable having that done by a gynecologist. Refer her. However, if it is of immediate concern, explain why you want to try to treat now rather than wait for a gyn to see her. If she still insists, try to get the gyn appt asap. If can't and she wants only gyn, then it's her decision - you just provide ALL of the info and support you can.

First do no harm.: The patient is in charge of their decisions at all times assuming they are not a minor and that they are competent for medical decision making. It is not your obligation to talk the patient out of specialty referral. Many patients make poor decisions about their health and as a doctor we can only serve as a guide. If they choose to reject your offer to evaluate and treat, that is their right.