Consultation, Referral Consultation, Referral and Networking in and Networking in Family MedicineFamily Medicine

DEPT. OF PUBLIC HEALTH & PREVENTIVE MEDICINEFACULTY OF MEDICINE

PADJADJARAN UNIVERSITY2013

7

Learning ObjectivesLearning Objectives

• Explain the principles of consultation and referral (C2)

• Explain how to write a good referral letter (C2)• Explain good communication and networking in

Family Medicine (C2)

INTRODUCTIONINTRODUCTION

• Deployment of all the resources of medicine and society• No continuing care, uncoordinated care wasteful and

dangerous

THE PLACE OF FAMILY MEDICINE IN THE PLACE OF FAMILY MEDICINE IN

HEALTH CARE: DIVISION OF LABORHEALTH CARE: DIVISION OF LABOR

TERTIARY CARE

SECONDARY CARE

HOSPITAL

BALAI

FIRST CONTACT CARE (GENERAL PRACTITIONER/ FAMILY MEDICINE SERVICE/ PUSKESMAS)

LOOKING AFTER PATIENTS THAT COULD BE MANAGED OUTSIDE THE HOSPITAL

PRIMARY CARE

ConsultationConsultation

Consultation

Second opinion, advise

Consultant(specialist, a family physician, a

member of the allied health professions)

Responsibility

Ask a colleague for his or her

opinion about the patient

ConsultationConsultation• SELECTION OF THE CONSULTANT MOST

APPROPRIATE TO THE PATIENT’S NEEDS RESPONSIBILITY OF FAMILY PHYSICIAN.

• A CONSULTATION

FORMAL ~ A CRUCIAL EPISODE IN THE PATIENT’S MANAGEMENT

INFORMAL ~ A PART OF THE DAILY LANGUAGE OF MEDICINE

THE FOLLOWING STEPS FOR THE THE FOLLOWING STEPS FOR THE

CONSULTATION IS TO BE EFFECTIVECONSULTATION IS TO BE EFFECTIVE

1. The physician requesting consultation should communicate directly with the consultant.

2. As a minimum, the letter requesting consultation should list all patient’s significant problems, state the physician’s main findings, the investigation that have been carried out, all medication and the purpose of consultation.

3. The reason for consultation should be explained to the patient.

4. The consultant should write back promptly, giving his or her findings and opinion.

Failure to consultFailure to consult• A failure by physicians to appreciate their own limitations• A feeling that consultation and referral are a personal

defeat

• Readiness to consult is a sign of maturity and self confidence

• Problem referring physician disagrees w/ the consultant’s opinion

• Each has an equal chance of being correct

1. Discuss the disagreement openly

2. Obtain a third opinion

REFERRALREFERRAL

TRANSFER OF RESPONSIBILITY FOR SOME ASPECT OF THE PATIENT’S CARE

Never total

Always retains

TYPES OF REFERRAL:TYPES OF REFERRAL:

1. INTERVAL REFERRAL THE PATIENT IS REFERRED FOR COMPLETE CARE FOR A LIMITED PERIOD

2. COLLATERAL REFERRAL THE REFERING PHYSICIAN RETAINS OVERALL RESPONSIBILITY, BUT REFERS THE PATIENT FOR CARE SOME SPECIFIC PROBLEM (LONG-TERM OR SHORT-TERM)

3. CROSS-REFERRAL THE PATIENT IS ADVISED TO SEE ANOTHER PHYSICIAN, AND THE REFERRING PHYSICIAN ACCEPTS NO FURTHER RESPONSIBILITY FOR THE PATIENT’S CARE.

4. SPLIT REFERRAL UNDER CONDITION OF MULTISPECIALIST PRACTICE ~ RESPONSIBILITY IS DIVIDED MORE OR LESS EVENLY BETWEEN TWO OR MORE PHYSICIAN

SUCCESSFUL REFERRAL DEPENDS ON SUCCESSFUL REFERRAL DEPENDS ON

GOOD COMMUNICATIONGOOD COMMUNICATION

GOOD COMMUNICATION

PATIENT

PHYSICIAN CONSULTANT

FAMILY

REFERENCESREFERENCES

1. Mc Whinney. A textbook of Family Medicine. Third Edition, Oxford New York, 2009. pp 379-85

2. Lee Gan, Azwar.A, Wonodirekso. Family Medicine Practice. Singapore, 2004. section 5 chapter 1, pp 112-9