Source: jordynredwood.blogspot.com
It is not unusual for a doctor to find a patient requesting to be referred to a specialist. To meet such request, it can be tricky particularly when the attending doctor deems that the referral is not necessary at that point. It should be noted that the request to be referred to a specialist is not necessarily a bad thing. It reflects that the patient is aware of his/her rights for further treatment and there could be various reasons why a specialist referral is requested.
Let’s take a look on common referral requests in the primary care settings:
- “I just want you to write a referral letter to a specialist for me to undergo a thorough medical check- up”.
- “My ear has a nasty discharge coming out from it. Can you please make a referral letter to the ENT surgeon for me?”
- “My eczema does not seem to resolve. I think I need to be referred to a dermatologist for better treatment”.
- “I think my headache is not a common one. I fear something sinister is going on in my brain. I need a CT scan referral”.
- “Can I be referred to gynaecologist for a PAP smear and mammogram?”
- “Why are you making it difficult for me to get a referral to the specialist?”
- “Doctor, I would rather be referred to the specialist now before it is too late for my illness and complications have set in”.
There are a few important things that a doctor needs to consider when a referral is needed. Let’s look at what a referral letter means in the medical profession.
A Referral Letter
A referral letter is a document or form containing the clinical impression and decision done regarding a patient’s ailment by the doctor at the clinic level. The referral letter would include the presenting complaints which brought the patient to the clinic in the first place, additional associated symptoms, relevant positive or negative clinical physical findings, laboratory and radiological investigations results, if any, and most importantly, the reason for the referral.
Role of Your Family Doctor
A family doctor or general practitioner should be the first point of contact whenever a person is ill. This can be the same doctor a patient seeks for treating both acute and chronic illnesses, performing antenatal and postnatal check-ups, baby check-ups, advising on preventive medicine, as well as screening for diseases and more. The doctor has the obligation to act as a gatekeeper for further health services and he/ she has to ensure that all the referrals to a specialist centre is appropriate. This is important to ensure that a patient will be attended by the right specialist in the right field. In addition, it is vital that all of the resources are appropriately utilised and there is no wastage of time and unnecessary cost incurred by the patient. The common ailments such as fever, cough and flu, uncomplicated asthma and simple skin disease do not require diagnosis from a specialist. These are basic diagnostic knowledge that a general practitioner must possess in order for him/her to practice in the medical profession.
When will my doctor refer me to a specialist?
A family doctor or a general practitioner has to take into account all factors prior to making a referral to any specialist. The doctor needs to consider that referring unnecessarily will cost you in terms of financial, time and energy. A family doctor would make a referral for a patient if…
- There are insufficient resources (medications, equipment, skills, and investigations) in the clinic setting to manage the patient’s condition;
- The patient needs to seek treatment in a better equipped secondary or tertiary centre;
- The patient has to undergo a more advanced diagnostic and therapeutic procedure;
- The doctor needs to get further expert opinion;
Given the conditions above, it is often that a family doctor finds it difficult to make a referral in the situations such as;
- A referral made in the state of ‘just in case’;
- A referral made on a patient’s request without medical evidence to warrant for further investigation;
- A referral made in order to get a second opinion without the patient first considering the initial opinion and diagnosis by the family doctor.
Where? Which specialist?
A doctor will ensure that a patient gets the right specialist for a medical condition or disease. If a specialist referral is deemed necessary, the doctor may have to decide which hospital he/she has to refer the patient, as there are differences in terms of facilities. One of the major considerations is the presence or absence of subspecialty services in the hospitals managed by either by the government or the private centres. For a referral to a private centre, the medical coverage by the insurance company or the company that a patient is working with is also taken into consideration.
It is advisable that a patient get the most out of his/her family doctor and avoid unnecessary waste of energy, financial and material resources by referring him/her inappropriately. Should a patient feels the need for a clearer and better explanation on his/her symptoms, it is highly recommended that the patient set up appointments with the family doctor for further discussion and to address the concerns and issues related to the illness.
Major Dr. Norhasyimah is a medical officer working in Kuala Lumpur and currently studying for her FRACGP.
[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.]
References:
- WHO: Management of health facilities: Referral systems. Available at: www.who.int/management/facility/referral/en/available
- Referrals within the profession -2007; Australian Medical Association. Available at: https://ama.com.au/position-statement/referrals-within-profession-2007
- National Healthcare Establishments & Workforce Statistics ( Primary Care ) 2010. Available at: http://www.crc.gov.my/nhsi/