Registrar’s message—revised Referral-Consultation Process guideline aims to keep patients out of the dark

Many of us have come to depend on electronic map applications on our smartphones when travelling. We take comfort in the ability to pinpoint our location, plan a route to our destination, get traffic updates, and ultimately know our estimated time of arrival. 

When navigating through the health-care system, patients are not afforded that same privilege. They often feel vulnerable and lost in transition when a family physician refers them to a specialist for a consultation. Waiting for an appointment with a specialist can be nerve-wracking, especially when waiting in the dark. 

As physicians, we have an obligation to help patients find their way. In 2017, the College began consulting with the profession and the public to identify gaps in the then-named guideline Expectations of the Relationship between the Primary Care/Consulting Physician and Consultant Physician. Patients told us that they weren’t clear on how long they were expected to wait before hearing back about an appointment, or who was responsible for maintaining continuity of care. Physicians also felt that the guideline wasn’t sufficient in terms of outlining their duties in the referral-consultation process. 

Following initial results, revisions were made by the College’s Patient Relations, Professional Standards and Ethics Committee and an externally selected advisory group consisting of two specialists and two family physicians. The proposed revisions to the document were sent out for consultation this past May, revised again based on responses, and then sent out once more in July. 

Now that the consultation process has concluded, the College is pleased to provide the profession with the final version of the guideline, now titled Referral-Consultation Process. 

The most important revisions made to this final version include:

  • acknowledging that the consulting physician is most often best suited to contact the patient with the appointment date and time; flexible language was purposefully used, as there may be circumstances where the referring physician is best suited to contact the patient
  • stating that a response from a consultant to a referral should be prompt (ideally two weeks) as opposed to four weeks
  • stating that an appropriate time for a consultant to provide a follow-up report to the referring physician after seeing the patient is two weeks to align with the MSP fee code

The College recognizes that there is a high degree of variability across the province in how referring physicians and consulting physicians engage in the referral-consultation process, including how a referral is first initiated and how information is subsequently transferred between physicians. As such, the document was intentionally kept as a guideline rather than a standard to allow flexibility in instances where the referral-consultation process is currently working well. 

Additionally, proposed time frames for responding to referrals and providing follow-up reports have been included as a reference, and best practice. Clearly there will always be circumstances where time frames may need to be adjusted to accommodate urgent cases or to triage cases appropriately. 

The guideline also addresses other concerns that were identified through feedback, such as the practice of sending the same referral letter to multiple specialists concurrently, which is not effective and can lead to obvious frustration. It also includes template examples of appropriate referral request, receipt and response letters.

There are many complex system issues that exist currently, which impact the referral-consultation process. Most of these issues are outside of the College’s regulatory mandate. This guideline provides principles for a referral-consultation process that focuses on the best interest of the patient, and assumes that both referring and consulting physicians have an important role to play. 

The main message is that physicians should provide clear, timely and reciprocal communication with colleagues, and engage with each other in a manner that ensures patients are informed along the way, and remain firmly at the centre of the referral-consultation process.

The guideline was approved by the Executive Committee on August 7, 2018. It can be found here.

Thank you to everyone who actively participated in this revision process.

Heidi M. Oetter, MD
Registrar and CEO

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