Merriam-Webster defines etiquette as “the rules indicating the proper and polite way to behave”. Others define it as “the customary code of polite behavior in society or among members of a particular profession or group”.
So what is professional etiquette when it comes to the referral-consultation process? As in many parts of life, the Golden Rule offers good advice: How would I want to be treated if I was the other physician?
Most importantly, how would I want to be treated as the patient? Surely the answer from all sides is with a level of consideration that ensures the best, most timely care.
At its meeting this September, Council considered feedback from the profession and others, and approved amendments to the Referral Consultation standard of practice. The amended standard clearly sets out expectations that define professional etiquette in how this process is managed.
One might think, perhaps, that doing so would be unnecessary. But, clearly, it is necessary. Too often we receive emails, calls and complaints about the behaviour of physicians on both sides of the referral-consultation equation.
For referring physicians, we hear concerns that:
- The information provided is insufficient (“please see and treat”, with no supporting information or documentation) and no attempt has been made to establish a diagnosis or even consider a diagnosis.
- The patient has not been properly examined (“please see re: cauda equina syndrome” when no rectal exam has been done/documented, for example).
- No clarity has been provided as to the goal of the requested consultation.
For consulting physicians, the list includes:
- Difficult access, manifest in a number of ways:
- refusal to see certain conditions within the scope of that specialty
- inaccessible processes for referring physicians (e.g., the office will accept new referrals only during one hour every fourth Monday)
- requirements for specific investigations to be completed (e.g., the patient must have an MRI of the XX body part before a consultation will be considered)
- delays in responding to the request for referral
- Failure to provide the consultation report in a reasonable time.
- Off-loading work onto the referring physician’s staff, the most common example of which is expecting the referring physician’s office to notify the patient of the time and date of the consultation.
If you see yourself or your practice in these bullets, then it may be time to look at how you run your practice or to ask colleagues who refer to you what you could do better.
In addition, I suggest you review the amended Referral Consultation standard of practice. While it has only a few changes, a couple are significant:
- The consultant must make information available to referring healthcare providers about the process for receiving requests for consultation (i.e., how to refer to you should be easily found and understood by referring healthcare providers), and
- The consultant must acknowledge receipt of a request for consultation to the referring healthcare provider within seven (7) days, and communicate to the referring provider the decision to accept or deny the request for consultation within a time commensurate with the urgency of the request but not longer than fourteen (14) days after the request was received. These timelines have been shortened, consistent with the recommendations of the Health Quality Council of Alberta in its Continuity of Care report.
- While not a change, this bears repeating: The responsibility to contact the patient as to the date and time – and any unique details – of the consultation remains with the consultant.
In my view, this all comes down to simple etiquette.
Your feedback and comments are always welcome.