The Referral-Consultation Process guideline must inform medical practice

The Registrar’s Message in the July/August edition of the College Connector introduced the revised Referral-Consultation Process guideline and described the extensive consultation with the profession and the public that informed its development.

Most BC physicians have operationalized the guideline in their practices, but the College is aware that a few have not. Some consultants have reportedly advised referring physicians that they regard the document as “optional” because it is a guideline and not a standard. This is a misperception. While guidelines permit “reasonable discretion” to opt for a different approach when circumstances call for one, in the event of a complaint or adverse outcome, physicians are potentially accountable for decisions not to follow guidelines in specific circumstances.

Opting out altogether is not acceptable.

Most College complaints arising out of referral-consultation transitions result either from the referring physician failing to continue to provide care until the patient is seen by the consultant, or by communication failures at the consultant’s office. The guideline is clear about the latter:

“In most situations, the consulting physician is best suited to communicate the appointment date and time to both the referring physician and the patient.”

To date, the small number of offices reportedly refusing to notify patients in this manner have been high-volume specialties: gastroenterology, otolaryngology and dermatology. A common attribute may be a relatively high volume of referrals. The College acknowledges that a large number of patients means a large number of calls. Physicians in private practice are obliged to employ sufficient support staff to allow them to comply with College expectations.

Last year the Inquiry Committee of the College investigated four complaints alleging deficient performance by a medical office assistant in the office of one busy proceduralist, including failure to answer or initiate phone calls. At interview it was clear that the office was simply short-staffed. The specialist committed to hiring a part-time assistant for return phone calls and the complaints stopped.

Reports that specialist offices are declining to contact patients to communicate the date and time of the appointment have been managed remedially. The College calls upon consultants who have not yet operationalized the guideline to do so without delay.