Consultation and referral

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Consultation and referral

  1. 1. Consultation and Referral Dr. Faisal Al Hadad Consultant of Family Medicine & Occupational Health PSMMC
  2. 2. Consultation vs Referral  Consultation: the doctor responsible for the patient asks a colleague for his or her opinion about the patient.  The term "consultant" in this context means a person who is consulted.  Referral: a transfer of responsibility for some aspects of the patient's care. Sometimes, the term referral used to denote both consultation and referral.
  3. 3. Consultation  It not binding.  The patient remain under the care of the physician requesting consultation  Most requests for consultation are from generalists to specialists.  Selection of the consultant most appropriate to the patient's needs is an important responsibility of the family physicians.  Two types of consultation: formal or informal.
  4. 4. Effective Consultation  The physicians requesting consultation should communicate directly with the consultant.  Consultation request should include: the patient's significant problems, the physician's main findings, the investigations carried out, the medications prescribed and the purpose of the consultation.  The reason for the consultation should be explained to the patient.  The consultant should write back promptly giving his or her findings and opinion to the physician requesting the consultation.
  5. 5. Difficult issues related to consultation 1. Consultation upon the patient request. 2. Disagreement of the referring physician with the consultant opinion: - discuss the disagreement with the consultant. - refer the patient back to the consultant for a reconsideration. - offer the patient a third opinion if he/she wish so.
  6. 6. Types of Referral 1. Interval referral: the patient is referred for complete care for a limited period. The referring physician has no responsibilities during this period. 2. Collateral referral: the referring physician retains overall responsibility but refers the patient for care of some specific problem 3. Cross referral: the patient is advised to see another physician and the referring physician accept no further responsibility for the patient's care.
  7. 7. ;Contd 4. Split referral: when responsibility is divided evenly between two or more physicians.
  8. 8. Referral System in F&CM Department 1. Referral is a joint decision by both the family physician and the patient. 2. Referral can be considered in the following conditions. 2.1. Unavailability of service or required experience. 2.2. Patient condition is out of scope. 2.3. Patient’s request for a second opinion 3. Referral is to be documented on the encounter sheet and the approved referral form.
  9. 9. ;Contd 4. Data pertaining to referral should include; personal data about the patient, important items in the history and physical examination, results of relevant laboratory and radiological investigation, provisional diagnosis and the reason for referral. 5. Referral form is composed of one original and two duplicates; the original form is to be kept in the patient’s medical record and the patient is given one duplicate and another duplicate is to be sent to Continuous Quality Improvement (CQI) unit.
  10. 10. ;Contd 6. Referral is either urgent or routine. This has to be specified in the form, and in case of urgent referral, the family physician will have to contact the referred to specialty on call to arrange for the patient to be seen immediately or arrange for a near appointment. In either case, this should be documented in the file along with the accepting physician name and time. 7. The need for referral should be explained to the patient and his family. This should be documented in the patient encounter sheet.
  11. 11. ;Contd 8. In case of routine referral, it is the patient responsibility to forward the referral duplicate form to the concerned appointment office for fixing an appointment.
  12. 12. Thank you

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