Who is checking the quality of referrals?

Issue: BCMJ, Vol. 59, No. 5, June 2017, page(s) 254,256 Letters
Stuart Holtby, MD, FRCPC, FAASM

The content and clarity of requests to provide a specialty opinion have perceptibly declined over my career as a consultant in respiratory and sleep medicine. Incomplete and inadequate referrals now hobble my work daily. Referring physicians’ questions or concerns are often vague and sometimes completely opaque.

Referrals are not accompanied by the results of tests already done or reports on therapies already tried. Summaries of active issues and major prior issues are rarely provided. Special needs are rarely mentioned, even when they are instantly obvious when the patient arrives—which is far too late for appropriate accommodation. Almost no physician provides information about the patient’s social/economic/personal situation.

My staff waste a lot of time chasing information that could and should have been provided at the outset. Patients always think I have that information (i.e., that the referring physician provided a clear summary). They are invariably surprised and sometimes very angry that I don’t have the information in hand. Their opinion of the referring physician (and the whole system) visibly falls.

On the other side, I also see many notes from consultants that don’t address questions clearly raised by the referring provider or the patient, don’t provide a clear and well-supported opinion or plan, and don’t outline how follow-up is to be arranged, or who is responsible.

I think most current consultation requests, and many consultant reports, are below the standard that the public expects, and far below the standard that a self-governing profession should require. I think our colleges and associations are sorely mistaken if they think current quality control systems are adequate. I think it is long past time for a frank review of this issue by the profession.

Am I alone in my opinions?
—Stuart Holtby, MD, FRCPC, FAASM


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