Too-Early Referrals; Easy One-Pot Lasagna

My sister-in-law Anna and I were discussing how frustrating it is to get a referral that turns out to be wayyyy too early. I’m braced for referrals that turn out to lead to no further action, and that those just HAVE to occur sometimes: the referral is like saying “Is this a problem?” and then sometimes the answer is “No, it’s fine.” It might feel like a waste of time or money (since you could see it as the doctor being wrong to worry), but it isn’t: the question needed to be asked and answered, and if the doctor is worried, I WANT her to refer me to someone who will know. But what I mean is when the referral turns out to be a sort of MISTAKE of the sort that wouldn’t be difficult to avoid.

For example, our dentist recently referred Edward to an orthodontist. Edward is only 9, so I thought I’d wait a bit: two earlier kids have needed orthodontics so far, but neither were able to start before age 11, and Edward’s situation didn’t seem severe. But the dentist was very insistent: Edward needed to go Right Now. So I took him, and the orthodontist kept saying things such as “only 9,” and “Let’s let him have some more childhood first,” and “only 9,” and “Edward, I can tell your mom is REALLY organized,” and “only 9.” (Luckily she also said things such as, “Now…WHY did you bring him in? Did you have…any particular concern?” so I could say “THE DENTIST MADE US.”) Since our orthodontist gives one free evaluation per patient, this means that when we have to go back in a year and a half, we’ll pay over $300 for that evaluation, which we wouldn’t have had to pay for if we hadn’t had this unnecessary evaluation now.

Anna mentioned a similar thing, where a doctor said her daughter needed to see a surgeon, so they took her to one, and the surgeon said, “Er, yes, maybe she’ll need surgery or maybe not, but we can’t know for three or four years.”

Perhaps doctors have no idea, which is WHY they refer to a specialist. But if that’s the case, perhaps there could be some way for them to FIND OUT a little more, perhaps a handy little chart of GENERAL GUIDELINES, such as “Do not refer to a surgeon three years before a particular surgery can even be considered.” It is such a huge hassle and expense to see a specialist, and too many unnecessary referrals gradually make me suspicious of motives.


SOMEONE recently recommended Easy One-Pot Lasagna. I’d thought it was Laura Diniwilk, but I can’t find it on her blog so it must have been someone else. If you wrote a post about a few recipes you’d recently tried, and one of them was this recipe, I’ll bet it was YOU. [Ah ha: Temerity Jane reminds me it was Linnea!]

Anyway, it looked good to me so I made it, and it was what I would call a hit for our family: Paul and I and three of the children all liked it a lot, and the children who liked it less still ate it. Downside: the melted cheese makes clean-up a pain. It doesn’t really matter to me if it’s “one pot,” if I have to use my fingertips to gradually wear down a fine layer of resistant cheese. But it might not be a problem in a non-stick skillet: because I was doubling the recipe, I needed to use a larger cooking pot.

And here I go with the “I made this recipe exactly, except I changed a bunch of stuff!” part. I used ground turkey instead of Italian sausage, because (1) whoever wrote the blog post I read about the recipe said she wasn’t crazy about the Italian sausage and wouldn’t use it the next time, and (2) the idea of peeling raw Italian sausages didn’t appeal (though I could have bought a packet of ground Italian sausage). Because I was using an unseasoned meat instead of a seasoned meat, I measured a little heavy on all the seasonings; I would use even more next time. I might also use more meat: I used a 1.3-pound package of ground turkey for a doubled recipe, so about 10 ounces of meat per batch, and that seemed a little skimpy. I didn’t use freshly-grated Parmesan; I used the kind in a plastic container. I didn’t buy fresh parsley and chop it; I skipped the garnish. I didn’t use freshly-ground black pepper or Kosher salt; I used the salt and pepper shakers on the counter. I like my one-pot meals with one-pot-type seasonings, and with fewer dirty graters and cutting boards.

25 thoughts on “Too-Early Referrals; Easy One-Pot Lasagna

  1. Nowheymama

    Yes about the referrals! What I really dislike is the hypothetical referral I sometimes get from our pediatrician and dentist. Like, “If this continues to be a problem, you should go to Dr. Soandso, and here is her card.” …? Do I call her now and give her a heads up? Do I wait a week? Do I put the card in a file and save it? Do I pat you on the back for giving me the answer I may or may not need in the future? WHAT DO I DO?

  2. Mir

    I am intrigued by this recipe, so thank you for that. I also feel compelled to mention that the last time I made a lasagna, I grabbed a new recipe which called for some lemon zest mixed in with the ricotta. I was skeptical, but it was life-changing. I will always do it that way, now.

    We recently blew a ridiculous chunk of money taking my oldest to a neurologist for migraines. When migraines run in our family. It was a complete waste of time and I guess I appreciate the pediatrician being cautious (and wouldn’t I feel stupid if she really did have a brain tumor, I guess) but… yeah.

    1. Swistle Post author

      YES, we had the same thing, when I was in college! We could barely cover the $5 student appointment co-pay, and the campus doctor referred me to a neurologist. Hundreds and hundreds and hundreds (I’m remembering $700 or something, but my parents likely remember the amount more vividly—and this was years and years ago) for a migraines diagnosis.

      1. Jenny

        On the other hand, I have severe migraines and am really happy to be in the care of a neurologist — I take all kinds of preventative medication and would basically be debilitated without them, and I’ve been adjusting them and switching them up since I was 15 to find the right balance that will keep me sane and mostly out of bed. So sometimes seeing a neurologist is really the right answer, and it’s not just for the diagnosis. It’s so hard to know when it’s the right thing and when the money will really be worth it.

    2. Katie

      They just have to do their due diligence. Migraines might run in a family but there’s always the chance that the patient could also have a brain tumour or something else.

      1. Swistle Post author

        And as Mir and my parents both felt at the time, they’d certainly feel stupid if there WAS a brain tumor. But considering the tiny, tiny chance of that, and the enormous and crippling expense involved in finding out it’s indeed NOT that tiny chance, there is certain justification in feeling….well, as people DO feel when that happens, and when they and not the doctor are the ones who have to write the check for that due diligence.

  3. kirsten

    Our pediatrician referred us to an autism clinic for testing. He was very emphatic that we needed to test as soon as possible so that our son could get the assistance he needed. After going, and receiving a positive diagnosis, he seemed very surprised, because he “just didn’t see it.” So what was the referral for?

  4. Shawna

    When making out gift want lists you may want to consider adding a pepper mill to yours next Christmas if you don’t already have one. Ikea has a great, inexpensive spice mill that keeps the grinder pointed upwards so you don’t get bits of ground pepper all over your counters and cupboards (which is the only real drawback to a pepper mill) and I’ve had mine for years.

    I have never in my life bought pre-ground pepper (and I don’t think my mother has either), and I am always puzzled when people talk about pepper shakers, or I see recipe photos on The Pioneer Woman that show her measuring out ground pepper. It’s so good fresh-ground and it’s really no more effort to keep a pepper mill full than a pepper shaker. (Or, you know, you may love your pre-ground pepper! It’s all good! In which case, ignore this unsolicited advice and carry on with your favourite pepper shaker!)

    1. Celeste

      If you can’t find the upward-grinding pepper mill, I follow this tip from a Cooks Illustrated reader and it works great: stand the pepper mill in a small ramekin that will belong to it. No debris on shelves, counters, or tables. Mine was about $1 at Pier 1.

  5. Tracy

    Our orthodontist likes to see patients early to make certain that there aren’t any problems that require precise timing. (For example, our son needed a Herbst appliance which needs to be done while he was growing into his adult face – i.e. age 12-13. A friend’s child needed that palate thing while 8-9?) Then you come back for periodic checks until treatment is needed – no cost for these visits. I’m curious if that’s unusual or if others don’t have to pay for repeat checks?

    1. Tracy

      Our orthodontist also does repeated free checks until the child is ready. Maybe you should call around Swistle. That’s pretty standard where I live.

  6. Barb.

    I don’t know about referrals — when my oldest was a baby/toddler, I kept asking if I needed to worry about dyslexia and/or autism (both run through my family) and getting my concerns poo-poo’d. Turns out he is very mildly autistic. I think insurance has a LOT to do with it… if I were to ask my kids’ doctor NOW, for instance, she’d write a referral right off, but now we have good insurance through my husband’s job. When my children were babies, all we had was CHIP, and we were treated as welfare cases as a result. My concerns were brushed off as gaming the system, I believe (omg, the stories. I. could. TELL.).

    Also, I have to agree with the fresh pepper comments. I only just started using fresh pepper instead of the pre-ground and both the smell and the taste is so incredibly different and better. Trader Joe’s sells a pre-packaged container of peppercorns with the upside-down grinder (comes with a little lid, too) that is very convenient and mess-free. Plus it is refillable, in case anyone is like me and LOATH to throw away/recycle perfectly good containers that can be reused. I don’t know about the fresh parm, though. I’ve yet to find fresh parm that tastes good so I tend to stick with the green container. It is a known quantity.

  7. Ruby

    I JUST made lasagna last night! I actually really like Italian sausage in lasagna, but I’ve found that a good alternative is Italian-seasoned ground turkey. It basically tastes like ground turkey, but you don’t need to add any extra seasoning to the lasagna.

  8. Sian

    If parsley is in a recipe in any quantity less than 1 cup, I refuse to buy it. Cost aside, I buy a bunch, chop a few sprigs, and then the rest melts in my crisper drawer. My battle cry of 2015 is, “Just say no to parsley!”

  9. Elisabeth

    My son was born with a fairly large halo mole on his back. When he was 2, our pediatrician was very insistent that we take him to a pediatric dermatologist. Our insurance doesn’t cover one in our state. The nearest one is at least 10 hours away from us. I took him to a normal dermatologist (still expensive). The dermatologist: “Well, he can have a major surgery right now where I have to put him under, or you can wait until he’s 8, keep the mole out of the sun, and do a minor inpatient procedure.” Needless to say, we’re waiting.

  10. Feisty Harriet

    My stepdaughter got braces on at age 8, OFF at age 9….and I still cannot believe that we paid money for this. APPARENTLY it is possible to “catch it early” and then not need more intensive braces later on, but she will wear a retainer for pretty much the rest of her life… Also, i think this might have been some kind of ploy for her mother (&#@$^@) to stick a huge, unexpected medical bill to my husband. But hey, it’s probably not that…… ahem.


  11. sooboo

    I had braces when I was 8 or 9 for about 3 years and then I had them again when I was 18 or so for about a year because my teeth started moving back to their formerly crooked state. I always wondered if I had had them a little later, whether that would have happened. But that would have meant headgear and retainers in high school. On another note, I hate being referred to a surgeon because in my experience, they always want to do surgery. They get a glint in their eye just talking about it and it’s hard to know if you legitimately need it or not.

  12. Rbelle

    We got a referral for my daughter’s gross motor delay that was too late. Nothing like being told, “No, we only take kids three and under for that,” when your kid just turned four. Then we had to figure out on our own where to go next, which was the school district, which referred us BACK to the doctor for a physical therapy referral because the delay wasn’t anywhere near severe enough for them to do anything about it, and did we really want to waste our time with all the testing for things she didn’t have? At which point the doctor told us that of course the school district said that, because they just want to save money, and if it was HER kid, she would go back to the school district. (This doctor uses “if it were MY kid” so much, I can’t even trust it anymore, especially since she doesn’t even have kids.) Ultimately, I pushed for the PT referral, which has been sitting on my desk for four months because my daughter seems to be improving on her own. Which is all to say that just hearing the word referral gives me a twitch.

  13. M.Amanda

    My father-in-law likes to cook messy stuff sometimes and is incredibly lazy. Rather than clean baked on cheese from a dish, he buys the big aluminum pans from the dollar store and throws them away after. Not practical for everyday, but nice for those “I just CAN’T deal with the cleanup” kind of dinners.

  14. Rene

    Fresh parsley makes such a difference (like the lemon in ricotta mentioned above). What I do is buy a bunch of parsley, wash it, dry it for a couple of hours on a dishtowel, chop it finely then freeze in a container. You can then take a teaspoon or more when needed for a recipe and it will be just as good as fresh and way better than the dry stuff. It’s important to make sure its really dry before freezing so it doesn’t clump in a big blob of parsley.

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