I believe the talk of taking-over patients from the periphery establishments has been on for centuries ever since the decentralisation of the service.
I personally believe that there are 2 types of referral in our medical world, I would arbitrarily call them type 1 and type 2;)
- Type 1 referrals - Referrals made on clear clinical grounds. Diagnosis is clear and the reason for referral is for the referred party to offer treatment modalities which are not available in the referring centre. Classic examples would be STEMI failed medical thrombolysis needing rescue PTCA, relapsed nephrotic syndrome needing renal biopsy, and acute subdural haematoma needing surgical evacuation.
- Type 2 referrals - Diagnosis is not clear. Referral is basically made to seek for opinion on a higher level. No clear plan outlined by the referring party. The referred party is hence asked for a suggested plan of management.
I've always emphasised to anyone that both types referrals are indicated and would probably deserve some respectable attention from the referred party. Type 1 means you have a rightful duty to be carried out. Type 2 means one of your other colleagues is in trouble and hence need help. Help in our medical fraternity is so vital that no single medical personnel can operate effectively without some collaborative strategies.
But the question comes always is that: "Should we take over all type 2 referrals and hence embrace all responsibilities?"
Unfortunately, there's no simple answer to this. It is, rightfully so, of a case-by-case basis.
Let me illustrate this further by referring to a referral which I'd received just yesterday from a district hospital.
A senior medical officer had called in to consult regarding the management of a patient with acute STEMI. After a long winded story, she in fact wanted me to take over this case to my hospital. I told her to thrombolyse on the spot as time was of the greatest concern in MI. She was reluctant as she had little experience in treating acute STEMI before. I was amazed by this very fact!
And then after much questioning and answer, I also found that she wasn't so sure about the diagnosis of MI! Patient hadn't got any chest pain. She admitted to me that she wasn't so good in looking at ECG! She told me that there was some funny changes in the ECG which could be an MI. She in fact was totally clueless of what's happening!!
I was speechless as to what I could offer to help. Obviously she probably needs to go back to medical school!!
This is somewhat I called a type 3 referral. Nothing fancy. Just an exaggerated form of type 2 if you like:(
Totally clueless, and hopefully you could dissect the case in the matter of minutes through phone conversation. Sorry, you don't have the luxury to examine the patient, let alone to take a history. Your diagnostic tool is just the strings of voices from the telephone!
But the question comes always is that: "Should we take over all type 2 referrals and hence embrace all responsibilities?"
Unfortunately, there's no simple answer to this. It is, rightfully so, of a case-by-case basis.
Let me illustrate this further by referring to a referral which I'd received just yesterday from a district hospital.
A senior medical officer had called in to consult regarding the management of a patient with acute STEMI. After a long winded story, she in fact wanted me to take over this case to my hospital. I told her to thrombolyse on the spot as time was of the greatest concern in MI. She was reluctant as she had little experience in treating acute STEMI before. I was amazed by this very fact!
And then after much questioning and answer, I also found that she wasn't so sure about the diagnosis of MI! Patient hadn't got any chest pain. She admitted to me that she wasn't so good in looking at ECG! She told me that there was some funny changes in the ECG which could be an MI. She in fact was totally clueless of what's happening!!
I was speechless as to what I could offer to help. Obviously she probably needs to go back to medical school!!
This is somewhat I called a type 3 referral. Nothing fancy. Just an exaggerated form of type 2 if you like:(
Totally clueless, and hopefully you could dissect the case in the matter of minutes through phone conversation. Sorry, you don't have the luxury to examine the patient, let alone to take a history. Your diagnostic tool is just the strings of voices from the telephone!
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This comes to illustrate what type of quality doctors the medical schools are producing nowadays. One also need to question whether these doctors are qualify to manage an ill patient in the first place. Extension of the compulsory training for HO to 2 years is justifiable.
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