Referrals

Re: Referrals

Gillian Mostyn — Tue, 08 Dec 2009 19:30:35 GMT

[quote user="Clive Elwood"]1. Do you refer cases?

Yes. When the case needs more expertise than we are able to offer.

2. What positive factors encourage you to refer to X?

Within a reasonable distance. Good communication. Straight-forward system for booking appointments. A practice that is happy to chat to us about cases before referral if necessary.

3. What negative factors discourage you from referring to Y?

Excessive costs. Poor communication. Poor treatment of cases (or their owners) in the past.

4. What is the most important factor in your choice of referral centre/specialist?

They have the necessary expertise!

5. How do you manage discussion about referral choices with the pet owner?[/quote]

Offer my recommendation first and then other options if there is a problem with transport there or anything else.

Re: Referrals

Hanna Bennett — Tue, 08 Dec 2009 14:32:52 GMT

I'll chip in my tuppence worth...

1. Yes, although we do deal with alot of cases in house.

Have a very experienced surgeon so really only refer spinal surgical cases - feel these require more frequent experience than we have.

Most medical cases get worked up in house unless we feel like we are banging heads against a brick wall. Do not have a very good endoscope so any cases requiring this get referred. Similarly anything neurological that appears to be central and may require further imaging/knowledge.

Refer difficult eye and skin cases simply as we do not see enough of these to gain either the detailed knowledge or kit required.

Refer some cardiology cases - mostly congenital ones where it is likely some more complicated procedure may be necessary.

Exotics where possible (!) are encouraged to see a specialist if the problem is not simple as i happily admit my alck of knowledge with many of these species.

2, Positive factors - prompt response from the referring practice to requests for referral appointments. It really helps if the referral practice agrees to contact the owner direct to arrange the appointment as i do not have all day to spend phoning back and forward to try and sort appointments out for my clients.

Letting us know when the appointment has been made for so i can organise referral letter/x-rays/directions etc for the client in good time. A willingness to arrange the referral appointment prior to receiving the history helps - very few of these are emergencies, and I may not have time to sort the history but do have time to phone and give the clients details.

Good previous results. Good client feedback.

Prompt follow up from the referral vet so that when the client sees us for their follow up appointment we know the details of the case. A willingness to discuss the case further when it is back under our care but things are maybe not progressing as well as expected.

3. Negative factors - requesting the history to be faxed before agreeing to make the appointment, then not letting us know the appointment has been made. Phoning to say they have not received the history and the client is waiting to be seen at that moment in time (but they wouldn't have made the appointment in the first place without the history...) and thus interrupting my consults by making me reprint the relevant history and referral letter. Not to be personal but one referral centre we use does this everytime. Really wouldn't use them except the particular vet i refer to there is excellent.

Poor communication. Took my own dog for orthopaedic referral for a soft tissue shoulder problem, appointment made fitted into my schedule fine the first time. Could not make the recommended revisit appointment so wanted to make it a week later, only to be told there were NO available appointments and to phone again at some (unspecified) point in the future to make one. Tried again the following week and they could not fit round my day off so said i'd wait for a bit more rota then phone again and see when to come. Phoned the third time to be told the vet i'd seen only consulted on Wednesdays - 7 weeks after my initial contact with them. Not impressed, have not referred anyone there since.

4. Most important factor for us is usually the distance the client is willing to travel. We are not exactly in a thriving metropolitan area, although good connections to various motorways locally mean you can be a long way away in a couple of hours. Some clients will travel, others really will not. This may mean compromising on the quality/facilities of the referral centre. Would agree with Wynne that having a selection of specialists on site is useful to ensure your case will be treated appropriately even if you have referred inappropriately - we had a Flat Coat who originally presented with pancreatitis, who then developed back pain and aniscoria. We referred her for that, turned out to have a lumbar disc (no idea what was causing the aniscoria) which they operated on, and then she developed AIHA while recovering at the referral centre - bet they loved us for that one! But at least she was treated for everything in one place.

5. Discussion about referral choices often starts ' I want to send your dog to see someone who knows more about this disease/condition and has the kit to investigate it more fully than we do, how far are you willing to travel?' If the answer is as far as it takes then the choice is mine, if not then I will discuss the pros and cons of the more locally available options.

Hope this is of some help.

Hanna

Re: Referrals

Arlo Guthrie — Tue, 08 Dec 2009 11:37:06 GMT

Bump

(Just putting this one back up the list; surely there are others who can help Clive ...)

Re: Referrals

Hannah Wynne Richards — Thu, 03 Dec 2009 15:02:28 GMT

Clive I'll deal with your questions 1 by 1

1) Yes

2)Past experience Good response, prompt appointment, attempt to fit in with clients other commitments. Most important of all-good clinical outcome. Patient seen by specialist, not fobbed off with inadeqately supervised resident -I know they have to gain experience somewhere, but in some places, they seem to bear the brunt of the referral service. These posts are meant to be training posts. They are not paid as income generating posts, and it is not fair to experienced referring veterinary surgeon, owner , or most of all patient to treat them as such. Good facilities If complex case, then a range of RCVS Specialists at the 1 site. Willingness of Specialists to discuss ongoing problems after discharge

3)Opposite of 2)

4)Try to get owners to go to centre offering all of above. Usual problem here is distance, so sometimes have to go for somewhere closer

5)When I feel I've reached my limit with a case I say something like "I don't think I can go much further with Fido. The best place I know of is :_ They are really brilliant, and if anyone can sort him out, they can. I know it's a long way, but everyone I've sent there is pleased" Take the discussion from there

Wynne