Consultation and Referral
Dr. Faisal Al Hadad
Consultant of Family Medicine
& Occupational Health
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
Referral: a transfer of responsibility for some aspects of
the patient's care. Sometimes, the term referral used to
denote both consultation and referral.
It not binding.
The patient remain under the care of the physician
Most requests for consultation are from generalists to
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.
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 reason for the consultation should be explained to the
The consultant should write back promptly giving his or her
findings and opinion to the physician requesting the
Difficult issues related to
1. Consultation upon the patient request.
2. Disagreement of the referring physician with the
- discuss the disagreement with the consultant.
- refer the patient back to the consultant for a
- offer the patient a third opinion if he/she wish so.
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
3. Cross referral: the patient is advised to see another physician
and the referring physician accept no further responsibility for
the patient's care.
4. Split referral: when responsibility is divided evenly
between two or more physicians.
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.
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.
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.
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.
The need for referral should be explained to the
patient and his family. This should be documented in
the patient encounter sheet.
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