Dear Dave,
You wrote:.
> Don't give objective referral
> criteria - spend your time educating them about the importance of a well
> funded support system like on-call and make sure that you deliver a high
> quality responsive service - then you hopefully won't feel the need to lay
> down criteria that limit what you might do.
I take your point, and can say that most of our doctors are aware of the
importance of the on-call service (very much so!), but feel that we may be
talking at cross purposes - I think I still have problems with your earlier
post in which you argued that, as referrals were requests for advice, then all
referrals were valid.
My argument is that we should not be asked to diagnose pulmonary oedema or
inadequate analgesia, or cure pyrexia, or treat perfectly well patients who
just happened to have been seen by a physio the previous day (all of which I
have done at some time.) These do not require the specialist skills of a
physiotherapist.
Doctors set out criteria for referral to each other - what we are doing is
nothing new. For instance, the Referral Guidelines for General Practitioners:
Which patients with limb joint arthritis should be sent to a rheumatologist?
(Dieppe and Paine, 1994). This article details a pre-referral checklist, a list
of what a rheumatologist is able to offer, and the question, "Is referral
always necessary?"
It goes on to say, "It is important that general practitioners are able to
recognise which people with musculoskeletal problems should be referred to the
specialist, and that they appreciate how to make best use of the resources."
For "general practitioners" read "hospital doctors," for "musculoskeletal" read
"chest". We are the specialists, and need no less careful consideration before
referral is made, even though we are cheaper than consultants!
Our on-call system may be well-funded, we may be responsive, but can we be said
to deliver a quality service if nobody knows how to make the best use of our
skills? I don't think that objective criteria limit our practice at all -
except that we won't get any more experience diagnosing pulmonary oedema or
inadequate analgesia, or cure pyrexia, or....
Regards,
Carol David
(Ref: Dieppe P, Paine T: Reports on Rheumatic Diseases: Practical
Problems.Series 3, No. 1, Jan 1994 Arthritis and Rheumatism Council,
Chesterfield.)
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