Physicians’ notes: The consequences of substandard communication for yourself, your colleagues and your patients

Read time: 2 minutes

Dear colleagues,

I’m a senior physician who has practiced for over 40 years as both a family physician and consultant. Most consultation requests I receive from my physician colleagues are sufficient for my needs. Sadly, some requests fall far below the minimum expectations outlined in CPSA’s Referral Consultation standard of practice.

It’s not unusual to receive a two- or three-line referral letter with no accompanying information on the patient’s medical history, medications, allergies, or relevant surgical, family and social history. In these cases, the referral recipient must spend additional time tracking down the information that should have been provided in the initial request. The recipient may even decline the referral due to lack of necessary information under clause 9(c) of the Referral Consultation standard of practice. The time spent gathering missing information and/or resubmitting referrals will delay and can negatively impact patient care.

At best, the referral might be considered “inadequate.” In a different light, it is frankly unacceptable, and not the proper way to treat a patient or colleague.

I draw your attention to bullet points two and three on page four of the Referral Consultation Advice to the Profession document:

“A complete referral includes:

• the purpose of the referral (e.g., a general opinion, second opinion, specific advice/procedure, etc.);
• the history of the current medical problem(s), including findings of examination and investigations, as well as a provisional diagnosis (if applicable);
• if applicable, specific treatments tried (in chronological order) and responses to them;
• current medications and known allergies;
• relevant past medical, surgical, family, and/or social history; and
• an enclosure of diagnostic studies (e.g., lab tests, diagnostic imaging, etc.) and communications from other consultants pertinent to the referral (if applicable).”

As outlined, it is our duty and professional responsibility to share pertinent patient information with our colleagues. In so doing, we are showing respect for our colleagues, who then supplement the narrative with their ascertained history and physical into a comprehensive consultation report back to us. By completing thorough referrals, we’re also showing respect for our patients, who may not remember therapies, chronology, test results or other pertinent details of their care.

Lack of communication is the common denominator in these situations and can lead to several issues you may have to navigate. If your communication is found wanting, it could lead to a variety of outcomes, such as an audit, patient complaint, remedial coursework and education.

Taking a couple minutes to provide a proper narrative, thus preventing the issues highlighted above, is well worth it to avoid potential negative repercussions—not to mention delayed or fragmented care for our patients. For those who do make a decent attempt to provide this information, thank you on behalf of all consultants. For those who don’t, I encourage you to reflect on how you could do better by your patients and your colleagues.

Sincerely,

An Alberta specialist

(This article was submitted to CPSA and is anonymous by request)