Who is checking the quality of referrals?

Issue: BCMJ, vol. 59, No. 6, July August 2017, Pages 296-297 Letters
By: Stuart Holtby, MD, FRCPC, FAASM

The content and clarity of requests to provide a specialty opinion have perceptibly declined over my career as a consultant in respiratory and sleep medicine.

The content and clarity of requests to provide a specialty opinion have perceptibly declined over my career as a consultant in respiratory and sleep medicine. Incomplete and inadequate referrals now hobble my work daily. Referring physicians’ questions or concerns are often vague and sometimes completely opaque. Referrals are not accompanied by the results of tests already done or reports on therapies already tried. Summaries of active issues and major prior issues are rarely provided. Special needs are rarely mentioned, even when they are instantly obvious when the patient arrives—which is far too late for appropriate accommodation. Almost no physician provides information about the patient’s social/economic/personal situation.

My staff waste a lot of time chasing information that could and should have been provided at the outset. Patients always think I have that information (i.e., that the referring physician provided a clear summary). They are invariably surprised and sometimes very angry that I don’t have the information in hand. Their opinion of the referring physician (and the whole system) visibly falls.

On the other side, I also see many notes from consultants that don’t address questions clearly raised by the referring provider or the patient, don’t provide a clear and well-supported opinion or plan, and don’t outline how follow-up is to be arranged, or who is responsible.

I think most current consultation requests, and many consultant reports, are below the standard that the public expects, and far below the standard that a self-governing profession should require. I think our colleges and associations are sorely mistaken if they think current quality control systems are adequate. I think it is long past time for a frank review of this issue by the profession.

Am I alone in my opinions?
—Stuart Holtby, MD, FRCPC, FAASM
Victoria

Stuart Holtby, MD, FRCPC, FAASM. Who is checking the quality of referrals?. BCMJ, Vol. 59, No. 6, July, August, 2017, Page(s) 296-297 - Letters.


Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.


For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org

BCMJ Guidelines for Authors

Leave a Reply