Julian Bradley wrote:
>> Agreed, is the responsible consultant going to see and examine all
>> these patients?
>>
>> A lab form is a referral to secondary care and should be treated
>> like any other.
>>
>> Trefor
>
> It's good to see this being debated and these views (which I share)
> put forward.
>
> Our X-ray requests get screened and bounced.
>
> I'm not sure the hospital even keep a copy of the ones they bounce.
>
> Less often referrals get bounced - e.g. a haematuria referral
> that doesn't include a signed US card.
>
> I find all this deeply unprofessional as well as deeply
> offensive but ... what can be done when hospitals play these games?
>
> Julian

I agree, a lab form + specimen, like an x-ray request, is a referral to
secondary care. It is therefore unprofessional, not to say impolite, to
fail to give the necessary information to allow for a proper opinion to
be given.

I speak as the husband of a radiologist who can tell many tales of
Barium meal requests that fail to mention a PH of gastrectomy, requests
for bone films that fail to mention a PH of breast carcinoma and
requests for skull x-rays that just say "? #", without specifying a
site.

She reported a pelvic x-ray today, and the GP's clinical details were
"told she had OA at rheumatology clinic". Needless to say, the film was
much the same as the one taken for the rheumatologist in February! Order
comms would have allowed the duplication to be picked up, and
unnecessary radiation as well as unnecessary expenditure avoided.

I would suggest that any protocol-driven referral process (which is
essentially what is being considered for moderated order comms) should
only be set up following a joint LMC-provider process. That way GPs can
advise on what is reasonable for a GP to provide in the way of
background information and the provider has authoritative support in
rejecting inadequate requests.

If it's any consolation, GPs are not the worst offenders in the dodgy
request stakes.

--
Michael