Consultation results on the guideline: Expectations of the Relationship between the Primary Care/Consulting Physician and Consultant Physician

Following is an overview of the feedback received from the profession:

  • 944 submissions were received in response to the consultation: 512 from general practitioners and 432 from specialists
  • 98% of respondents (both GPs and specialists) agreed that the expectations of the referring physician and the duties of the consultant are clearly stated in the current guideline; however, both GPs and specialists felt that these expectations and duties are not being followed consistently by their colleagues in practice  

Common themes from the open-ended survey comments:

  • Referral letter/request completion/written reports following consultation: Referral letters should contain relevant information about the patient’s condition with explicit detail about why the patient is being referred, and similarly, the written report to the referring physician should be clear in terms of diagnostic/therapeutic interventions, and proposed next steps
  • Repeat/retrospective referral: If a consultant arranges a follow-up appointment with a patient, a re-referral for the same patient and problem should not be necessary
  • “Shot-gun” referrals: Referral requests are sometimes sent to multiple physicians in the hopes of avoiding wait-times; respondents agreed that this practice is counterproductive and should be avoided.
  • Refusal of referrals: Respondents felt there should be clarity on when it is appropriate to reject a referral request (e.g. referral should have been sent to another specialist with a defined scope of practice or expertise).
  • Process for urgent consultation: Verbal communication should be required and accommodated in urgent situations rather than a written referral.
  • Acknowledgement of referral: Good practice suggests that consultants should acknowledge receipt of a referral.
  • Communication re: wait times: Consultants should provide estimated wait times to the referring physician in order for the referring physicians to assess whether or not to refer to another specialist.
  • Responsibilities re: continuity of care: Referring physicians, consultants and the patient must be clear on who is responsible for the provision of ongoing care to the patient following a consultant visit.

Many comments were provided regarding systemic issues, such as long wait times, and hospital admission practices. These issues are outside of the College’s scope and regulatory mandate, and will not be included in the revised guideline. 

During this first round of consultation, the College also sought input from patients who are directly involved in and affected by the referral process. Through the Patient Relations, Professional Standards and Ethics Committee, the College will develop a revised draft of the guideline, which will be circulated to the profession for review and discussion in the New Year. Thank you to all physicians who participated in this process.