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

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 TERTIARY CARE SECONDARY CARE HOSPITAL BALAI FIRST CONTACT CARE (GENERAL PRACTITIONER/ FAMILY MEDICINE SERVICE/ PUSKESMAS) LOOKING AFTER PATIENTS THAT COULD BE MANAGED OUTSIDE THE HOSPITAL PRIMARY CARE

5. Consultation Consultation Second opinion, advise Consultant (specialist, a family physician, a member of the allied health professions) Responsibility 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 1.The physician requesting consultation should communicate directly with the consultant. 2.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. 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.

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 1.Discuss the disagreement openly 2.Obtain a third opinion

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

11. 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 SHORT- TERM) 3.CROSS-REFERRAL THE PATIENT IS ADVISED TO SEE ANOTHER PHYSICIAN, AND THE REFERRING PHYSICIAN ACCEPTS NO FURTHER RESPONSIBILITY FOR THE PATIENT’S CARE. 4.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 GOOD COMMUNICATION PATIENT PHYSICIAN CONSULTANT FAMILY

13. 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