7

Consultation, Referral
and Networking in
Family Medicine

DEPT. OF PUBLIC HEALTH & PREVENTIVE MEDICINE

FACULTY OF MEDICINE
PADJADJARAN UNIVERSITY
2013

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)

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

THE PLACE OF FAMILY MEDICINE IN HEALTH

CARE: DIVISION OF LABOR

TERTIARY CARE

SECONDARY
CARE

PRIMARY
CARE

HOSPITAL

LOOKING AFTER PATIENTS

THAT COULD BE MANAGED
OUTSIDE THE HOSPITAL

BALAI

FIRST CONTACT CARE (GENERAL

PRACTITIONER/ FAMILY MEDICINE
SERVICE/ PUSKESMAS)

Consultation

Responsibility

Consultation
Second opinion, advise

Ask a colleague
for his or her
opinion about the
patient

Consultant
(specialist, a family physician, a
member of the allied health
professions)

Consultation
SELECTION OF THE CONSULTANT MOST
APPROPRIATE TO THE PATIENTS NEEDS
RESPONSIBILITY OF FAMILY PHYSICIAN.

A CONSULTATION

FORMAL ~ A CRUCIAL
EPISODE IN THE
PATIENTS MANAGEMENT

INFORMAL ~ A PART OF
THE DAILY LANGUAGE
OF MEDICINE

THE FOLLOWING STEPS FOR THE

CONSULTATION IS TO BE EFFECTIVE
1. The physician requesting consultation should
communicate directly with the consultant.
2. As a minimum, the letter requesting consultation should
list all patients significant problems, state the physicians
main findings, the investigation that have been carried
out, all medication and the purpose of consultation.
3. The reason for consultation should be explained to the
patient.
4. The consultant should write back promptly, giving his or
her findings and opinion.

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

 Problem referring physician disagrees w/ the

consultants opinion
Each has an equal chance of being correct

1. Discuss the disagreement openly

2. Obtain a third opinion

REFERRAL
ve
e
N

al
t
o
rt

TRANSFER OF
RESPONSIBILITY
FOR SOME
ASPECT OF THE
PATIENTS CARE

Al
w
ret ays
ain
s

TYPES OF REFERRAL:
1.

INTERVAL REFERRAL
THE PATIENT IS REFERRED FOR
COMPLETE CARE FOR A LIMITED PERIOD

2.

COLLATERAL REFERRAL
THE REFERING PHYSICIAN
RETAINS OVERALL RESPONSIBILITY, BUT REFERS THE PATIENT
FOR CARE SOME SPECIFIC PROBLEM (LONG-TERM OR SHORTTERM)

3.

CROSS-REFERRAL
THE PATIENT IS ADVISED TO SEE
ANOTHER PHYSICIAN, AND THE REFERRING PHYSICIAN ACCEPTS
NO FURTHER RESPONSIBILITY FOR THE PATIENTS CARE.

4.

SPLIT REFERRAL
UNDER CONDITION OF
MULTISPECIALIST PRACTICE ~ RESPONSIBILITY IS DIVIDED
MORE OR LESS EVENLY BETWEEN TWO OR MORE PHYSICIAN

SUCCESSFUL REFERRAL DEPENDS ON

GOOD COMMUNICATION

PATIENT

FAMILY

GOOD
COMMUNICATION

PHYSICIAN

CONSULTANT

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