Communication between specialties

As a doctor, you are not expected to be infallible, but you are expected to put yourself in a position to make a reasonable clinical judgment and manage the patient appropriately thereafter. This includes making an adequate assessment of the patient’s condition, arranging appropriate investigations and, if it is indicated, referring the patient to another practitioner.

Referrals

Be sure the patient understands the reason for the referral and has appropriate expectations

First of all, be sure the patient understands the reason for the referral and has appropriate expectations. If you are not yet using Choose and Book, you should also give patients an estimate of when they should expect to get an appointment, and tell them what to do if they haven’t been contacted within the expected time.

You are responsible for ensuring that the patient is referred to an appropriate specialist and, if you delegate the task of shortlisting using Choose and Book, the responsibility remains with you (see Box 14).

When making a referral, indicate the degree of urgency and provide all relevant clinical details (including the history, clinical signs and, when appropriate, physical examination).

Box 14: Responsibility of the referrer

"When using Choose and Book, it is the clinical responsibility of the referrer (eg. GP) to short-list those services that are appropriate for their patient’s needs. If, however, the referrer delegates the task of short-listing services (and thus completing an ‘Appointment Request’) to a non-clinician, even if this is within a standard protocol framework, they need to be satisfied that those to whom they delegate are competent, appropriately qualified, experienced and are provided with sufficient information to undertake the task delegated to them. The Clinician will still be responsible for the overall management of the patient, and accountable for the decision to delegate.”

NHS Factsheet: Clinical Responsibilities when Delegating Actions in Choose and Book (Version 2) (December 2010)

  

Communicating with patients

Patients who are kept informed about their condition and are involved in deciding on the appropriate treatment are more likely to comply with the treatment you suggest, and less likely to complain if things go wrong. It is particularly important that you tell patients about the possible side-effects of drugs or treatment you are ordering, and that they know what complications to look out for and what to do if they develop.

Warn patients about the risks before carrying out any procedures or prescribing medication. “Informed” consent is dealt with in more detail in the MPS Guide to Consent.

If patients are receiving treatment, tell them when to return for review and what symptoms or signs of adverse effects or changes in their condition to report. If possible, give them an indication of when they might expect to see an improvement in their condition, and when to call you if it doesn’t transpire within a certain timescale.

Document any advice you have given the patient. It is useful to document in the record any supporting literature or written information given to the patient.

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