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By Dr Biswajit

Followup is critical for referrals

This is a pretty common scenario in practice — Lakshmi has been seeing you for a deep nagging cough that is not responding to antibiotics. You realise that she needs to be sent to a higher center. You are in a hurry for there are ten others jostling at your door eager to get into the clinic. You quickly put down a few sentences addressing a letter to the specialist or maybe you have just about enough time to scribble together a note on a pad. You tear out the page, and hand it out to Lakshmi so that you can move onto the next one in line. And even before the patient has stepped out of your clinic, for you the matter is settled. Done!

For you this was a routine referral or handover to another doctor. But did you? A handover is complete only when the other doctor accepts your referral and initiates treatment.

You have no idea what happened to the patient who walked out of your clinic with a torn slip of paper in her hand. You do not know if the patient did visit the doctor. Even if she did, you do not know if the specialist found anything significant or do anything about it at all.

So why is this a problem?

Its easy to sweep such issues under the carpet. After all, you haven’t even treated the patient. So how can it affect you!? In general, people don’t like to be shuttled around from one place to another. And in the end, as patients, if they achieve very little in that exercise, it disturbs them and leads to dissatisfaction. An unhappy patient can prevent other potential patients from reaching you. So beware! Over time, a build up of such referrals can make or break your practice.

Those who are aware of this aspect of patient care take great pains in the referral of patients that go beyond their clinics. If you were not so busy, you could pick up your phone and call the referral doctor. And if you do it right in front of the patient, it will boost her confidence in you as her caretaker. Such a patient will return to your care even after completing treatment with the specialist. Plus she will vociferously recommend you to all her near and dear ones.

If you don’t like talking, some of us don’t (including myself!!), you could resort to email to do the same. The plus point of email over phone is that the referral gets documented. Unlike a phone conversation that vaporizes the moment you keep your phone down, in the case of email, you could always go back to your inbox to refresh your memory about the case.

Yes, you could use whatsapp and messenger services as well. But your important referral is likely to get lost in the deluge of silly jokes and memes that your phone gets bombarded with. With the increasing data breaches being reported it is not the safest place to converse about a patient.

But where’s the time to call, mail or chat?

Wouldn’t it be nice if you had a simple way of making a note of the referral — maybe the name of the patient, a brief description of her clinical issue and the specialist to whom you are referring the patient to. And if the referral doctor acknowledged your referral and started a back and forth conversation, would you not be happy about it?

More importantly, over time you could develop a rapport with this specialist. Practice building is all about developing relationships, and wider relationships will build a network. Access to such a network can prevent you from feeling helpless when confronted by a difficult clinical case, for now you have access to a specialist who can partner with you in sorting out the clinical problem.

You have to find those few minutes to record the referral, even if you are the busiest doctor on earth. Documenting a referral enables follow up even if it is after a gap of few days or even weeks. The cycle of treatment is complete only when the patient that you referred is back to your clinic. Follow up enables completion of this cycle. Completion of the cycle indicates a happy patient. And a single happy patient will bring in more patients.