all team members understand their personal and collectiveresponsibility for the safety of patients, and for openly and honestly recording and discussing problems;
each patient's care is properly co-ordinated and managed and that patients know who to contact if they have questionsor concerns;
arrangements are in place to provide cover at all times;
regular reviews and audit of the standards and performanceof the team are undertaken and any deficiencies areaddressed;
systems are in place for dealing supportively with problemsin the performance, conduct or health of team members.THE ETHICAL REFERRAL SYSTE
ONG HEALTH PROFESSONIALS:Life is too vast for a single doctor to be an expert in all thedimensions of medical care, the reason why specializations must be pursued.
there is no single therapy for a single disease;
there is plurality of diagnosis as every condition can be
seen differently since a diagnosis is just an opinion;
recognition of one¶s limitations even as one has to work
above all for the best interest of the patient.
referring a patient to another doctor is never a sign of one¶s incompetence but a sign of professionalism,and a matter of principled nobility and honor.ETHICAL REFERRAL SYSTE
arnings to Health professionals:referral system can only work best when doctors honor SIR ³smooth Interpersonal relationship´ that must be pursued and promoted at alltimes;solicitation of patients is very unprofessionaland is awfully distasteful.
Referral involves transferring some or all of theresponsibility for the patient's care, usually temporarily and for a particular purpose, such as additional investigation,care or treatment, which falls outside your competence.
In order to utilize fully the expertise of specially trained consultants, it is recommended that referrals be made by generalists as well as by specialties whenever appropriately provided.
The referral is the attending physician¶s soledecision.
The reason for the referral and expected outcomesare adequately explained to and accepted by the patient or his qualified guardian.
Good judgment, communication, honesty and goodwill underlie the process.
The consultant must be informed of the referral directly by the attending physician or through his or her delegated authority (resident physician or staff nurse) after the request is duly recorded in the patient¶s chart.
The purpose of the referral must be specified: evaluation,diagnostic procedure, co-management, etc
A consultant can refuse to accept a referral.
Once he or she accepts, he/she cannot delegate theresponsibility to another
His or her responsibility will depend upon the specified purpose of the referral.
If a consultant accepts the referral it is his or her duty to answer the same as soon as possible and to write his evaluation/ recommendations on theconsultation sheet provided by the hospital.
If the referral is for evaluation, the consultant¶s primary responsibility is to the attending physician. It is to him that the consultant must give his or her opinions and suggestions, not tothe patient.
His or her responsibility will depend upon the specified purpose of the referral. (continued)
If the referral is for co-management, his or her primary responsibility is as co-attending physician. The consultant must, however,continue to communicate with the referring physician under whose service the patient wasadmitted.
A consultant cannot delegate responsibility to anassistant, fellow, or resident. It is precisely toutilize his or her expertise that the consultation ismade.
If during the course of treatment the consultant cannot continue attending to then patient, theattending physician must be notified for appropriate action.
To assure a coordinated effort that is in the best interest of the patient, the attending physician should remain in chargeof overall care, communicating with the patient and coordinating care on the basis of information derived fromthe consultations.
Consultants should not make cross referrals but may suggest it to the attending physician.
The attending physician who does not agree with theconsultant's recommendations is free to call in another consultant.
After the condition for which the patient was originally referred has been resolved, the consultant should submit aseparate professional fee and end his/her services.
Follow-up, future consultation, etc. should be by the original attending physician, unless these are delegated to theconsultant through a subsequent referral.
In case of life threatening conditions, when the attending physician is not available, any physician involved in the casemust do what he deems as necessary for the best interest of the patient.
In case of readmission or consultation for a new complaint, patient¶s autonomy should be respected. The consultant should however encourage the patient to return to his or her original physician
Delegation involves asking a nurse, doctor, medical student or other health care worker to provide treatment or care onyour behalf.
It is unethical to delegate authority for patient care toanyone, including another physician, who is not appropriately qualified and experienced.
ARRANGING RELIEVER DELEGATION REFERRAL RELATIONSHIPS