Something About Referrals

In my recent calls, I received numerous referrals from my colleagues, of which some were pretty much out of expectation. Of most interest was a referral by my former senior cardiology colleague.

He asked me to review a middle-aged lady who had multiple myeloma and complained of atypical chest pain which was pricking in nature. Her ECG had shown 0.5mm T inversions from V1 to V4. He told me that he was sure that it was nothing of cardiac in origin. Nonetheless he still would want me to see. Just to cover his track as he said.

I saw instantly and repeated an ECG which showed T inversions from V1 to V3 of the same morphology. I proceeded to demonstrate to the ward nurses the way to 'reproduce' the inverted T in V4. I placed the V4 lead closer to the sternal border and wahlah! ..T wave was inverted again in V4. I wrote down my assessment and offered my opinion that it was non-cardiac atypical chest pain.

Well, don't get me wrong. I'm in no way against any referrals from my colleagues. It's the professional codes that dictate every doctor to see referrals and to offer assistance to the very best interests of patients. Nevertheless, referrals must be indicated, and if possible, be optimised, so that limited resources and manpower could be channelled to the necessary individuals and patients. We live in a world with scarce and limited resources. This, unfortunately, we can't change.

If my former senior cardiology colleague was sure about the diagnosis, why refer? This is something for everyone of us to ponder about.

What'd be your say?