Re: Bad booking protocol

Dr Wilkinson’s letter raises a critical concern: Patients should not be left wondering whether a referral has been received or how long they may wait for care. However, individual physicians are not solely responsible for clear, effective communication, and this is not simply a question of professionalism. It is a question of how our increasingly complex health care systems can facilitate communication in ways that improve the patient experience as well as overall system efficiency.

The College of Physicians and Surgeons of BC’s Referral-Consultation Process guideline emphasizes timely, clear communication and shared responsibilities between referring and consulting physicians. These principles are important. However, achieving them requires designing a system to support the principles, rather than simply adding more administrative tasks to a physician’s workload.

Doctors of BC’s Council on Health Economics and Policy has repeatedly highlighted the cumulative burden of administrative work. Tasks that appear small and reasonable in isolation, such as an additional phone call, email, or form, become substantial when multiplied across hundreds or thousands of patients. The result can paradoxically be less physician time available for direct patient care.

Referral communication is, therefore, best approached as a system-design problem. Patients should receive confirmation that their referral has been received, information about anticipated wait times when available, and clear instructions about whom to contact if their condition changes. But these functions should increasingly be supported through coordinated referral systems, technological infrastructure, and cross-platform communication that supports notifications, wait-list management, and appropriately resourced administrative teams. Our province’s health care system is far too complex for this to be an individual clinician’s burden.

Patients deserve transparency, but physicians also deserve systems that enable transparency without having to take on the responsibility of operationalizing it.
—Inderveer Mahal, MD
Editorial Board Member, BC Medical Journal

This letter was submitted in response to “Bad booking protocol.”