Sunday, September 20, 2015

Making Referrals - Bio Medical Ethics

Hey awesomites, I'm Jay, and I'm your new Medicowesome contributor! yayy!! :) And today we are going to talk about Referrals. This is another important ethical responsibility of a physician.

A physician’s Central responsibility is WELFARE OF THE PATIENT, and that means, Physician should work for the best interest of the patient not him/herself.

Referral simply means that, when we reach the boundaries of our competence, we should hand our patient to a more competent physician. Keeping a patient with ourselves to hide our incompetency or to earn more money is a huge NO-NO!!!

We shouldn’t be ashamed to ask for help from our colleagues, and we shouldn’t be continuing to treat a patient, if we cannot give him/her a fruitful therapy as our boundary of competency has reached. That’s when we should write a LETTER OF REFFERAL to a Consultant(BritE)/Attending(AmE) Physician or to another colleague with a broader knowledge or idea of the subject.
Even if you have the ability to continue the therapy for the patient may be the institution you work for (ex: the hospital) may not provide long term therapies. Then also you will have to refer the patient to another institution.

If in any case the patient decides your therapy in his case is unfruitful and wishes to see another physician, you are bound to let the patient leave to another physician and write a formal referral letter stating the current situation of your patient.

Guidelines to write a good referral letter:

  • Be clear, concise,and precise, especially with emergency referrals – Every physician is a busy person. Make sure you write the details to the point neither exaggerating nor ignoring. And make sure every important detail is written in an easily comprehensible manner.
  • Make sure you tailor the letter to the person who will read it. More junior members of staff might need more explanation than specialists. – Also this is the point you have to identify if you are writing to any consultant in a specified department or if you are writing to a particular specialist you assume to have more in breadth experience in a case like you are handing in. In the former instance, only mention the title and the department, but in the latter case, make sure you mention the name of the particular specialist.
  • Start with the introduction of the patient with important vital and/or clinically significant factors, and explain why the referral is needed functionally and describe any relevant social circumstances. Use wording to detail history and investigations and highlight relevant information.
  • If you are unclear of the diagnosis, tell the specialist what you want from them, providing your differential diagnoses. Do not be afraid to admit your ignorance.
  • Advise on the patient’s ideas, concerns and expectations of a hospital appointment and explain if there may be involvement of stress or anxiety in the patient’s condition. Also if you intend to let your medical colleague know that it’s under patient’s request you do the referral, you can opt to use a phrasing like “Please see this patient who requests your opinion on…” which perfectly acceptable.
  • It’s usually acceptable to address a senior colleague/specialist, as “Dear sir/Madam”, and a physician in an equal status as “Dear Colleague,” in the salutation of the letter (Ex : Between two GPs, or between two specialists).
  • Finally, end the letter with a phrasing like “Please accept him under your care” or similar to imply that you hand over the patient to your colleague’s care.
  • Make sure you finish your letter with your signature, name, and preferably your official stamp/seal mentioning your credentials and the national/state/provincial registration number.

So, I think today I gave you a good understanding on referring a patient and how to write a referral letter as a physician. See you all soon! :)

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