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Point of discussion
Referral And Consultations

Learning objectives
At the end of this session student have to be able to explain the referral and consultations with other professionals

Referral and Consultations

Introduction The existing public health referral systems and health service delivery mechanisms focusing on: a) medical and laboratory services and, b) selected programme operations, This has involved an examination of public health referral systems in various districts in Indonesia in order to ascertain their effectiveness

Referral and Consultations

Referral is a process by which a health worker transfers the responsibility of care temporarily or permanently to another health professional or social worker or to the community in response to its inability or limitation to provide the necessary care.
Referral is a two way process and it is done from the community to the primary care health service and to hospitals and within hospitals and vice versa. A referral may be for temporary, permanent or partial transfer of responsibility for the care of a patient.
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Referral and Consultations

Professional interactions with physicians, dental specialist, general dentists and other professionals are an important part of daily dental practice. Severely compromised medical status, complex treatment for a diagnosed condition, or the suspicion of an un diagnosed illness are among situations in which the dentist may seek the advice of the patients physician The general dentist also commonly requests the participation of other general dentist and dental specialist during the course of the patients dental care

Referral and Consultations

Effective patient referrals and consultations are fostered by clear communication professional, common sense and a genuine concern for the patients welfare. Failure to follow the unspoken rule can effect in adverse event and leave a negative impression

Referral and Consultations

The principal aim The principal aim of the referral system 1. Diagnostic 2. Health care 3. Patient status 4. Second opinion

Referral and Consultations

The principal aim The principal aim of the referral system 5. To save the patients money : the public purse is paid correctly to dentists and is paid correctly according to the regulations (cost and benefit)

6. The treatment provided was warranted and has been satisfactorily completed (quality assurance)
7. The oral health of the publics has been secured, maintained, and promoted

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COMPONENT OF REFERRAL SYSTEM AND CONSULTATION GENERAL DENTIST HOSPITAL AND PUBLIC HEALTH SERVICES

DENTAL SPECIALIST

MEDICAL SPECIALIST

THE AIMS OF THE REFERRAL AND CONSULTATION

1. 2. 3. 4. Diagnostic Health Patient status Second opinion 5. Cost and benefit 6. Quality assurance 7. Wllfare promotion

Referral and Consultations

Referral is contact between two professionals in which the primary care provider requests the active participation of another professional in some portion of the patients treatment. These terms may be used interchangeably in cases in which the active treatment participation by the consultant depends on the opinion formulated during the initial consultation.

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Referral and Consultations

Consultation is the communication between two professionals regarding the status of a patient and treatment options for any problems. This implies that the consultant does not take an active part in the actual treatment but serves in an advisory capacity to the primary care provider.

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Referral and Consultations

Patients may need to be referred for several reasons.
Level of training and experience of the dentist Dentists areas of interest Extensiveness of the problem Complexity of the treatment Medical complications Patient load Availability of special equipment and instruments Staff capabilities and training Patient desires Behavioral concerns Desire to share responsibility for patient care Geographic proximity of the specialist or consulting dentist
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REFERRAL FORM Referring Physician Prompt Sheet The beginning of the letter should include the following: 1. Patients name, address, date of birth, health number and contact information, (e.g. telephone number or email address) 2. Referring physicians name and contact information, (e.g. telephone/fax numbers and email addresses) 3. Consulting physicians name, address and contact information 4. Urgency of referral - urgent, semi-urgent, routine or elective

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REFERRAL FORM Referring Physician Prompt Sheet Other Important Information: Reason for referral Provisional diagnosis (is an initial guess, to be narrowed or confirmed
later based on further examination.)

Succinct history of problem related to reason(s) for referral and/or other problems Relevant information on patients medical status morbid conditions and relevant past history or old notes Current and recent medications Clinical warnings / significant findings on examination
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REFERRAL FORM Referring Physician Prompt Sheet Other Important Information: Copies of test results What the patient has been told Any factors possibly mitigating against particular treatments or arrangements Special considerations, (e.g. psychiatric/social problems, concerns about compliance or patients understanding; need for an interpreter; any other concerns/wishes of patients family) Follow-up / role of referring physician who will resume care after consultation Finish with a note of thanks for help in managing patient and a list of other recipients to whom copies of the consultation letter should be sent. 17

CONSULTATION FORM Consulting Physician Prompt Sheet

The beginning of the letter should include the following: 1. Patients name, address and date of birth 2. Consulting physicians name, address and contact information 3. Referring physicians name and contact information

Other Important Information: Reason for consultation Chief complaint / relevant history Additions to problem list and/or summary of current status of medical conditions Findings - clinical findings on examination, including test results Investigations / Interventions Diagnosis confirmed or differential
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CONSULTATION FORM Consulting Physician Prompt Sheet Treatment and management plan
o

o
o o o

o
o o

Aim of treatment Options considered and supported / not supported Recommended treatment and management Proposed treatment schedule with reasons Anticipated benefits and risks of treatment Changed or newly prescribed medication(s) Likely short and long-term complications Possible effects of treatment on patients quality of life and functional capacity Contingency plans in event of adverse events from (or failure of) first-choice treatment

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CONSULTATION FORM Consulting Physician Prompt Sheet

Prognosis Psychosocial aspects, (e. g. patients understanding, psychiatric / social problems) Follow up arrangements Who and when to review the patient following the consultation, including any situations which may prompt an earlier review Finish with a note of thanks to referring physician for help in managing the patient and list other recipients to whom copies of the consultation letter have been sent.

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Referral and Consultations Elements of dental patient referrals

Communication from the Referring Dentist to the Specialist or Consulting Dentist: (The information may vary on
an individual patient basis, it could include) :

Name and address of the patient Scheduled appointment date and time with the specialist or consulting dentist Reason for the referral/diagnosis General background information about the patient which may affect the referral Authorization or release of records
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Referral and Consultations Elements of dental patient referrals Medical and dental information, which may include:
o o o o

Medical consultations and specific problems Contributory dental history Diagnostic casts Radiographic or digital images

- Future treatment needs beyond the referral

Urgency of the situation, if an emergency

Information already provided to patient

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Referral and Consultations

Communication from the Referring Dentist to the Patient:

Many times the referral process is unfamiliar to dental patients. The referring dentist may wish to consider the following points when communicating with the patient: An assessment of the patient's ability to understand and follow instructions An explanation of the reason for the recommended referral to the patient, patients parent or legal guardian as appropriate An explanation of which area of dentistry or specialty is chosen and why
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Referral and Consultations

Communication from the Referring Dentist to the Patient:

If possible, making a specific appointment with the specialist or consulting dentist

If known and if requested by the patient, providing information about the specialist or consulting dentists fee for the consultation or evaluation
Giving instructions that will assist the patient's introduction to the specialist or consulting dentist, i.e., preoperative instructions, educational pamphlets or a map with directions

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Referral and Consultations

Post Referral Communication Between the Specialist or Consulting Dentist and the Referring Dentist: Communication between professionals is essential. Patients should receive clear, consistent information about their dental problems and treatment from all dental professionals. Mixed messages can confuse and frustrate patients. The following steps can facilitate the communication process:
o

Initial report from specialist or consulting dentist indicating the preliminary diagnosis and anticipated treatment Progress reports as necessary, if treatment is extended over a considerable period of time
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Referral and Consultations

Post Referral Communication Between the Specialist or Consulting Dentist and the Referring Dentist: Final report, including factors that may alter the future course of therapy or affect the relationship between the referring dentist and the patient. Diagnostic quality copies or duplicates of radiographic or digital images taken by specialist or consulting dentist

Return of any pertinent documents or forms provided by the referring dentist

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Referral and Consultations

Legal And Ethical Issues

Some of the legal and ethical considerations pertaining to referrals are noted below
Legal Considerations:
o

The law may bear on whether and how a referral may be made. For example the refusal to treat a patient with HIV would require a scientific basis;
A referral to a clinic with more experience treating persons with HIV or any disability cannot be based solely on the dentists personal level of comfort.
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Referral and Consultations

Legal And Ethical Issues

Some of the legal and ethical considerations pertaining to referrals are noted below
Legal Considerations:
o

Communication from the referring doctor may be mandatory, in others it may be permitted, and in others patient consent may be required.

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Referral and Consultations

Legal And Ethical Issues

Dentists should recognize that separate and possibly conflicting legal interests may be involved during a referral.
Particular attention should be directed toward patients or providers whose interests and requirements are detailed in contract form. When dentists or patients participate in such arrangements related to dental services, these arrangements should be reviewed carefully

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Referral and Consultations

Consultation with other professionals Situation occasionally arise in which professionals other than physicians and dentists can contribute to the dental health and management of the patient. For example, the patients pharmacist can certainly provide a listing of the patients current medication, dosages and the medication regimens.

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Referral and Consultations

Consultation with other professionals The nursing staff of extended care facilities can be exceptionally helpful in advising the dentist of the patients capabilities In that situation, the exchange of information is more likely to be by telephone conversation or personal contact than by formal consult letter.

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CONSULTATION & REFERRAL SYSTEM

Consultation : communication 2 experts Consultant : an expert Referral : is a system communication between 2 expert

OUTCOME

CONSUL TANT

PHYSI CIAN

Goals

: 1. Diagnostic 2. Health care 3. Patient status 4. Second opinion : 1. Material 2. Patient 3. Scientific
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PATIENT

Items

Referral System

What should be treated on oral finding

All of the findings or oral clinical findings which usually suffered as patients chief complain Any kind of oral problems Categorization of oral disorders
Inflammation and infection CongenItal abnormality Immunology disorders Traumatic lesion Compromised Neoplasm Others

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What is the chief complaint?

Is the patients problem or problems Is something that make them discomfort

What are something that make them discomfort?

Pain, acute infection, bleeding and traumatic injury Inflammation and infection, CongenItal abnormality, Immunology disorders, Traumatic lesion, Compromised, Neoplasm, Others
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What factual problem are to be solved?

Problems related to chief complain
Pain, acute infection, bleeding and traumatic injury

Problems potential to medical complication

Compromised, pregnant woman, radiation

Problem related to oral problems

dental problems, supporting tissue problems, acrylic works problems, dysfunction, mobility, others

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Chief complaint

the disease

Patients perception What is the complain is the facts What is the disease abstract in nature

Doctors perception What is the complain abstract in nature What is the disease is the facts
Examples : Ulcer patients fact doctor ?

!
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Complaint
Sign & symptom

Complaint analysis
The actual problem Treatment planning Treatment

The disease
Structural problem Functional problem Treatment planning concept Medical risk analysis Drugs risk analysis
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Unknown lesion or disorders

Post treatment 6 evaluation

Treatment
2
Problems related to the chief complaint Problems related to medical complications Problems related to oral disorders Inflammation and infection CongenItal abnormalities Immunology disorders Traumatic lesion Compromised Neoplasm Others

Treatment prep
Oral assessment Treatment planning

Referral & Cons

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Concept

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