Abstract • We prospectively studied the communication between 27 referring practitioners and their consultants for 464 consecutive patient referrals from a general internal medicine group practice at a university medical center. The rates of referral among practitioners varied from 0 to 28.1 per 100 patient visits. Though referring physicians provided patient background information in 98% of the cases, they made explicit the purpose of the referral in only 76% of the cases. They contacted consultants directly in only 9% of the cases. In return, consultants communicated their findings to referring practitioners in only 55% of the consultations. Referring physicians who personally contacted consultants or who supplied them with more clinical information were more likely to learn the results of the consultation. While communication between the referring physicians and consultants in this setting is limited, it may be improved if referring physicians supply more clinical information to consultants and contact them directly. (Arch Intern Med 1984;144:1265-1268) References 1. Williams TF, White KL, Andrews LP, et al: Patient referral to a university clinic. Am J Public Health 1960;50:1493-1507.Crossref 2. Williams TF, White KL, Fleming WL, et al: The referral process in medical care and the university clinic's role. J Med Educ 1961;36:899-907. 3. Morrell DC, Gage HG, Robinson NA: Referral to hospital by general practitioners. J R Coll Gen Pract 1971;21:77-85. 4. Kunkle EC: Communication breakdown in referral of the patient. JAMA 1964;187:663.Crossref 5. Rudy DR, Williams T: The consultation process and its effect on therapeutic outcome. J Fam Pract 1977;4:361-363. 6. Metcalfe DHH, Sischy D: Patterns of referral from family practice. NY State J Med 1973;73:1690-1694. 7. Cummins RO, Smith RW, Inui TS: Communication failure in primary care. JAMA 1980;243:1650-1652.Crossref 8. Hines RM, Curry DJ: The consultation process and physician satisfaction. Can Med Assoc J 1978;118:1065-1073. 9. Long A, Atkins JB: Communications between general practitioners and consultants. Br Med J 1974;4:456-459.Crossref 10. Curry RW, Crandall LA, Coggins WJ: The referral process: A study of one method for improving communication between rural practitioners and consultants. J Fam Pract 1980;10:287-291. 11. Popkin MK, Mackenzie TB, Hall RCW, et al: Physician's concordance with consultant's recommendations for psychotropic medication. Arch Gen Psychiatry 1979;36:386-389.Crossref 12. Popkin MK, Mackenzie TB, Callies AL: Consultees' concordance with consultants' recommendations for diagnostic action. J Nerv Ment Dis 1980;168:9-12.Crossref 13. Mackenzie TB, Popkin MK, Callies AL, et al: The effectiveness of cardiology consultation. Chest 1981;79:16-22.Crossref 14. Sears C, Charlson M: The efficacy of a consultation: Promotion of compliance with recommendations, abstracted. Clin Res 1980;29:259A. 15. Lee T, Pappius EM, Goldman L: Impact of inter-physician communication on the effectiveness of medical consultations. Am J Med 1983;74: 106-112.Crossref 16. Goldbloom RB: The lost art of consultation: A plea for the return of the striped trousers. Pediatrics 1975;56:347-348. 17. Tumulty P: The Effective Clinician: His Methods and Approaches to Diagnosis and Care . Philadelphia, WB Saunders Co, 1973, chap 5 . 18. Phelps LA, Renner JH: The development of a 'statement of policy regarding consultations.' J Fam Pract 1977;5:979-981. 19. Homer MJ: A radiologist's point of view. JAMA 1981;246:2581-2582.Crossref 20. Schroeder SA, Kenders KK, Cooper JK, et al: Use of laboratory tests and pharmaceuticals. JAMA 1973;225:969-973.Crossref 21. Brock C: Consultation and referral patterns of family physicians. J Fam Pract 1977;4:1129-1134. 22. Shortell S: Determinants of physician referral rates: An exchange theory approach. Med Care 1974;12:13-31.Crossref 23. Ludke RL: An examination of the factors that influence patient referral decisions. Med Care 1982;20:782-796.Crossref 24. Mendenhall RC, Tarlov AR, Girard RA, et al: A national study of internal medicine and its specialties: II. Primary care in internal medicine. Ann Intern Med 1979;91:275-287.Crossref 25. Rudd P: Contrasts in academic consultation. Ann Intern Med 1981;94:537-538.Crossref 26. Saunders TC: Consultation-referral among physicians: Practice and process. J Fam Pract 1978;6:123-128.
Archives of Internal Medicine – American Medical Association
Published: Jun 1, 1984