It the process that involve seeking the assistance of another specialist with a resource to guide in managing a specific problem and sharing responsibility in patient care. Ideally, it would result in “a closed referral loop”, in which the referral appointment is completed and results are then shared with the patient’s referring physician. Apart from consultants and hospitals, a referral might be considered to family physician colleagues with special interests or expertise, and other members of the primary health care team, such as physiotherapists, dietitians, and social workers.

2. Lecture Outline
The Referral Process
Reasons for patient referral
Family physician role in referral
Before the referral
The referral letter
Referral letter contents
Referral feedback

3.  It the process that involve seeking the
assistance of another specialist with a
resource to guide in managing a specific
problem and sharing responsibility in patient
care.
 Ideally, it would result in “a closed referral
loop”, in which the referral appointment is
completed and results are then shared with
the patient’s referring physician.
 Apart from consultants and hospitals, a
referral might be considered to family
physician colleagues with special interests or
expertise, and other members of the primary
health care team, such as physiotherapists,
dietitians, and social workers.
TheReferralProcess

4.  The family physician can handle 90-95% of
problems encountered in his daily practice,
and makes appropriate and timely referral of
the rest patients to optimize the health
outcome of them.
 One of the main family physician
responsibilities is the Coordination Of The
Patient’s Care in order to meet the needs of
the patient.
 It is the family physician’s responsibility to act
as a Gatekeeper to guide the patient through
the health care system for good quality and
cost-effective care.
Coordinationof thePatient’sCare

5. ReasonsforPatientReferral
1. To undertake a service, such as a
diagnostic work-up or therapeutic
procedure.
2. For a second opinion to confirm an
unclear diagnosis.
3. For the management of the patient
problem, or one aspect of it.
4. Only to reassure the patient.

6. 1. The family physician is responsible for handling
several aspects of the referral process, including a
selection of the desired specialist and provision of
the required referral information.
2. In addition to written information, it is often
helpful to call the receiving doctor directly to
discuss the patient’s condition with him before the
consultation.
3. At all times, the family physician should act as the
focal reference point and maintain control of
patient management.
FamilyPhysicianRoleinReferral

7. 1. Explain to the patient and accompanying relatives
the reasons for the referral.
2. Prepare them mentally and financially, especially
when surgery is expected.
3. Selection of appropriate specialty and appropriate
physician in the field.
4. Consideration is given to the patient's medical,
emotional, cultural and socioeconomic background.
5. Try to make an appointment for the patient.
6. Phone directly for urgent conditions and early
appointments.
7. Write an optimum Referral Letter.
BeforetheReferral

8. TheReferralLetter
Referral letter is an essential means of
communication between primary and
secondary care, giving the receiving clinician a
detailed summary of the patient’s condition to
ensure a smooth transition of care.
 Referral should be made by letter or, if
available, by electronic booking.
 Until electronic referral replaces written
referrals, the art of letter writing will
continue to be an important skill.
 Writing a good referral letter is not easy
and needs practice.

9. RulesforWritingaReferralLetter
1. Write in clear, coherent sentences,
expressing the problems as
accurately as possible.
2. Use short words and phrases,
avoiding rambling sentences.
3. Use simple language, avoiding
colloquialisms, medical jargon, and
abbreviations.
4. Make the referral letter legible: type
if possible.

10.  The patient details: e.g., full name, date of birth,
gender, and health number.
 The history of presenting complaint.
 Examination: key positive and negative findings.
 Investigations: relevant positive and negative
results.
 Relevant past, social, and therapeutic histories.
 Reason for referral: e.g., investigation, diagnosis,
treatment.
ReferralLetterContents
The basic elements of the referral letter include:
Finally, the letter must be signed, dated, and has
referring doctor’s contact details.

11.  In well-ordered circles, the receiving
physician will write back a reply letter
(feedback) to the family physician with
an opinion about the patient’s
problem(s) and answer the questions
the family physician has raised.
 When a reply has been received, the
family physician has to review the
patient and put into action any new
management plans that have been
decided upon.
ReferralFeedback

12. Further details about Medical Ethics & Informed Consent
have been discussed in the second edition of my book
"Essentials of Practicing Family Medicine", Chapter 6.

13. See you in the next
lecture:
Obtaining Informed
Consent