When a doctor from a given specialty like rheumatology for example will see a patient and when finds that there is a certain problem in that patient’s case that requires a consultation from another specialty, like chest or kidney for example, in that case doctor A, the rheumatologist, will refer the patient to doctor B in that specialty, chest or kidney, to consult him.
The process of referral of a patient to another specialty and his coming back with the referral back letter from that specialty has rules. We teach them to doctors, not patients, in the courses of communication between doctors. The problem here is that the number of doctors who study or have studied communication is not big and the breaching of the rules in this process is not uncommon and, most importantly, this is one area where awareness of the patients with this problem can help prevent it and prevent the delays that it causes in the process of patient care sometimes.
When I decide to refer a patient to another specialty, I write down the referral to the other doctor stating clearly the needed details of my patient’s case and stating clearly the reason for the referral, what my question is clearly. Ideally, I should write in good handwriting; handwriting that is readable by anyone unless I am typing of course. I never tell the patient verbally you should see a chest doctor. I don’t do that. I give him a written or printed referral. This is the first part of the referral process.
Now we come to the second part of the referral process that is no less important than the first.
The doctor from the other specialty, after reading the referral, will evaluate and assess the patient of course and after that, in an ideal setting, we expect him to do three things:
One: he will write his response to the referring doctor. Two: he will answer the reason to the referral clearly of course. Three: he will write back in readable handwriting unless he is typing of course.
It is not acceptable practice that he tells the patient, when you go back to your doctor, tell him that you have this problem, or tell him that there is no problem and there is no need to worry or tell him when he reads my prescription, he will understand everything on this own or tell him that it is a very simple thing and it does not require to write a referral back. “Tell him” is not an acceptable response in any referral process. I always educate my patients on that issue and tell them if you go to a “tell him doctor”, this means you did not go to a doctor and with the same referral that I gave you, you will need to see another doctor from this specialty who responds to referrals the way referrals are responded to.
This point is so important as it causes delays in patient care sometimes and I have noticed that patients who are made aware of this point, they do contribute to preventing it and preventing the delays that it causes.
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This post was prepared and published by Dr. Hatem Eleishi. Dr. Hatem Eleishi is a professor of rheumatology at Cairo university (Egypt) and is especially dedicated to supporting arthritis patients with online educational videos and articles about arthritis causes and treatment. He also runs a rheumatology clinic in Cairo and a center for www.tabibakom.com/en that, in addition to providing online rheumatology consultations, also provides online medical consultations in several different medical specialties by expert consultants from Egypt, Canada and the United States.
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