Registrar's message—An update on the development of revised professional guidance on the referral/consultation process

In the September/October edition of the College Connector, we reported on the results of a consultation with the profession and public on the existing guideline related to the referral process, which was conducted over the summer. After further analysis of the results, and a number of in-person meetings with medical leaders this fall, one consistent theme has emerged—that the primary issue affecting patient care throughout the referral process is a breakdown in communication.

Breakdowns exist between referring physicians and consultant physicians at the time of the referral, during the transfer of care, and after the consultation has occurred. Specialists who participated in the survey had numerous concerns about the quality of the referral letter, including inadequate information about the patient or the reason for the referral. Similarly, referring physicians expressed frustration with the amount of time it takes to hear back from a consulting physician, or receive a report following a consultation. Inevitably, and inexcusably, patients get caught in the middle, often left wondering who they should expect to hear from, and worrying about what to do next.

The College has a mandate to establish practice standards and professional guidance to ensure patient safety; physicians have a responsibility to be aware of these resources and be compliant with the expectations contained within them. Effective communication between health-care professionals and their patients is a hallmark of good medical practice, and, as a professional imperative, shouldn’t require strict regulatory oversight. This is a multi-faceted, challenging situation to address, seen through the eyes of many. While participating physicians expressed hope that the College could regulate a solution, even the most carefully crafted practice standard or professional guidance document won’t provide a cure for all ills in this instance. All physicians must take responsibility for the part they play to ensure patient-centered care in a complex health system. This is what inspired most of us to choose medicine as a career in the first place.

As a next step in the process, the College is planning to work with a small advisory group of practising GPs and specialists to establish a framework for the new document, which places the patient firmly at the centre of the referral process. It will stress the importance of a timely exchange between physicians, appropriate follow-up, and professional courtesy to ensure patients don’t fall through the cracks. 

In addition to the professional guidance the College is developing, new modes of electronic communication may also offer solutions for a more streamlined referral process in the future, including transfer of care with ready access to patient information as required. We are also hearing of innovative initiatives being led by the Divisions of Family Practice across the province, and invite all of you to contact the College if you have ideas to share about improving the referral process in your community. 

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We appreciate your collective wisdom and experience as we develop this professional guidance. Further updates on the process will be available in future editions of the College Connector.

Note: Other concerns were raised through the consultation related to systemic issues, such as long wait times, shortages of certain specialists in specific communities, and hospital admission practices. These issues are outside of the College’s scope and mandate, and will not be addressed in the revised document.

Heidi M. Oetter, MD
Registrar and CEO