A number of considerations go into the decision of to whom to refer. The longstanding tongue-in-cheek description of the most important characteristics of a good consultant has been the three “a”s (in order: availability, affability, and ability). Geographic considerations are often significant factors and, regrettably, insurance arrangements and managed care increasingly represent nonmedical issues that dictate the choice of consultants. The major factor, however, should be the track record of the consultant. For each of us, the experience of how our patients have done after consultation and/or procedures is almost certainly the most important factor in deciding whom we refer to. However, we may be in the position of referring for a problem with which we have not had much experience. Therefore, it behooves us to know, not only how well our own patients have done, but also the overall performance of colleagues whom we might consult. Such information is not always readily available.