A Tale of Two Consults

I received an interesting consult this week. It read "I think I'll let this man describe his own symptoms to you."

I sometimes get referral letters that carry brevity to the extreme: "BPH" and "ED" come to mind. One referring doc occasionally sends a one letter consult: "P". I don't know if he means "prostate problems" or "difficulty P-ing". I'm sure this brevity is meant to be witty.

But, this is the first time I've received a referral that essentially said "Surprise!"

A referral letter doesn't need to be lengthy, but it should convey a few essentials such as the nature and urgency of the problem, past medical history and pertinent test results. From this, I can decide how quickly I need to see the patient and what other tests I should be arranging for her.

In Saskatchewan, it's not unusual for someone to drive 3 or 4 hours for their consultation with me, so I try to coordinate necessary testing to take place on the same day as the office visit with me so as to spare patients extra trips. If I don't have the necessary information in the referral letter, my patients pay the price (literally).

Adequate information in a referral letter also lets me schedule a suitable appointment duration. Our usual visits are booked for 15 minutes. If I anticipate a more complex problem, I'll book from 30 to 60 minutes.

Consider another patient I saw this week. This man's family physician sent a referral letter indicating a complicated problem that had been going on for over a year. He detailed previous treatments and pertinent test results. From that letter, I could tell that 15 minutes would not be adequate, so I booked 45. At the end of the visit, the man asked me how long I usually spent doing a consultation. I explained that I would usually spend 15 minutes, but that his doctor's thorough referral letter prompted me to arrange a longer visit. He replied that this was the longest time he had spend with a doctor and seemed quite pleased not to be rushed through the visit.

He was satisfied. I was happy not to feel rushed (I hate to keep my next patients waiting). All the necessary test results were available, so I didn't have to track down results and then phone the man with my final opinion. Efficient!

Thank you to my family physician colleagues who routinely send appropriate information in their referrals. The time you spend composing that letter saves time and expense for your patient, and makes their visit with me more productive and satisfying.