Consultation, Referral and Networking in Family Medicine

1. 7 Consultation, Referral and Networking in Family Medicine DEPT. OF PUBLIC HEALTH & PREVENTIVE MEDICINE FACULTY OF MEDICINE PADJADJARAN UNIVERSITY 2013

2. Learning Objectives • Explain the principles of consultation and referral (C2) • Explain how to write a good referral letter (C2) • Explain good communication and networking in Family Medicine (C2)

3. INTRODUCTION • Deployment of all the resources of medicine and society • No continuing care, uncoordinated care wasteful and dangerous

4. THE PLACE OF FAMILY MEDICINE IN HEALTH CARE: DIVISION OF LABOR LOOKING AFTER PATIENTS THAT COULD BE MANAGED OUTSIDE THE HOSPITAL TERTIARY CARE HOSPITAL SECONDARY CARE BALAI FIRST CONTACT CARE (GENERAL PRACTITIONER/ FAMILY MEDICINE SERVICE/ PUSKESMAS) PRIMARY CARE

5. Consultation Responsibility Consultation Second opinion, advise Consultant (specialist, a family physician, a member of the allied health professions) Ask a colleague for his or her opinion about the patient

6. Consultation • SELECTION OF THE CONSULTANT MOST APPROPRIATE TO THE PATIENT’S NEEDS  RESPONSIBILITY OF FAMILY PHYSICIAN. • A CONSULTATION FORMAL ~ A CRUCIAL EPISODE IN THE PATIENT’S MANAGEMENT INFORMAL ~ A PART OF THE DAILY LANGUAGE OF MEDICINE

7. THE FOLLOWING STEPS FOR THE CONSULTATION IS TO BE EFFECTIVE • The physician requesting consultation should communicate directly with the consultant. • As a minimum, the letter requesting consultation should list all patient’s significant problems, state the physician’s main findings, the investigation that have been carried out, all medication and the purpose of consultation. • The reason for consultation should be explained to the patient. • The consultant should write back promptly, giving his or her findings and opinion.

8. Failure to consult • A failure by physicians to appreciate their own limitations • A feeling that consultation and referral are a personal defeat • Readiness to consult is a sign of maturity and self confidence

9. Problem  referring physician disagrees w/ the consultant’s opinion • Each has an equal chance of being correct • Discuss the disagreement openly • Obtain a third opinion

10. REFERRAL Always retains Never total TRANSFER OF RESPONSIBILITY FOR SOME ASPECT OF THE PATIENT’S CARE

11. TYPES OF REFERRAL: • INTERVAL REFERRAL THE PATIENT IS REFERRED FOR COMPLETE CARE FOR A LIMITED PERIOD • COLLATERAL REFERRAL THE REFERING PHYSICIAN RETAINS OVERALL RESPONSIBILITY, BUT REFERS THE PATIENT FOR CARE SOME SPECIFIC PROBLEM (LONG-TERM OR SHORT-TERM) • CROSS-REFERRAL THE PATIENT IS ADVISED TO SEE ANOTHER PHYSICIAN, AND THE REFERRING PHYSICIAN ACCEPTS NO FURTHER RESPONSIBILITY FOR THE PATIENT’S CARE. • SPLIT REFERRAL UNDER CONDITION OF MULTISPECIALIST PRACTICE ~ RESPONSIBILITY IS DIVIDED MORE OR LESS EVENLY BETWEEN TWO OR MORE PHYSICIAN

12. SUCCESSFUL REFERRAL DEPENDS ON GOOD COMMUNICATION PATIENT FAMILY GOOD COMMUNICATION PHYSICIAN CONSULTANT

13. REFERENCES • Mc Whinney. A textbook of Family Medicine. Third Edition, Oxford New York, 2009. pp 379-85 • Lee Gan, Azwar.A, Wonodirekso. Family Medicine Practice. Singapore, 2004. section 5 chapter 1, pp 112-9

14. Thankyou