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In response to comments requested in the last Bulletin, Council has become aware that, in some circumstances, it has become common practice for consultants to require multiple consultation requests from the primary physician as part of the initial assessment of a patient. In other words, the patient may be initially assessed for a particular problem and appropriate investigations arranged. However, the consultant would then not provide further advice to the patient, or to the primary physician, without another consultation being requested. Council noted that this matter was addressed by the Professional Review Committee of Medicare in 1992. An excerpt from a letter to all physicians at that time stated:

"There are certain conditions for which continuing care is inherent in the management of the patient prior to his/her being discharged from the consultant's care. Although this may not be considered primary care, it is care, nevertheless, for a patient who has been accepted for a diagnosis and/or treatment, and neither the patient, nor the primary physician, would be well served by the patient being bounced back and forth between the consultant and the referring physician in order that follow-up visits may be billed as consultations."

Having said that, Council's only concern here is that there be no unnecessary impediment to a patient's access to timely medical care. In this light, Council believes it would only be in exceptional circumstances that more than one request for a consultation should be required in the initial assessment. A reasonable approach, evidently already followed in most circumstances, is for the consultant to provide an opinion, arrange appropriate investigations, and see the patient as required in follow-up visits. To demand, or request, that such follow-up visits be further consultations cannot be in the best interests of appropriate patient care. Council wishes to remind members that a consultation, by definition, is initiated not by the consultant, but by the primary physician. Having said that, Council does believe it is acceptable for a consultant to offer to reassess the patient, at the request of the primary physician, as part of long-term follow-up, such as on an annual, or semi-annual basis. Such a request would be a valid consultation.

06/04