The key element in the consultation process is communication. In this context, a physician, upon making a request for a consultation, should provide all reasonable information relevant to the matter.  This should address both the urgency of the matter, as well as sufficient background information for the consultant to both assess the matter and later properly assess the patient.  This generally would include copies of any reports or other documents relating to the specific situation.  A request for consultation can be forwarded by any means, but must be documented in the patient’s record.  If there is a specific urgency, the documentation should be accompanied by a direct contact, at least with the consultant’s office, to ensure that the material will be received and read in a timely manner.  If a consultant arranges to see a patient without a referral, the consultant must not insist on a request for consultation from the patient’s primary care physician.

Upon receipt of the consultation request, the consultant must acknowledge such promptly (two weeks or less) with an informative response to the referring physician either accepting or not accepting the referral.

If, at any time subsequently, the consultant determines the consultation cannot be completed, the referring physician should be advised immediately.

If a specific appointment is available, such information must be provided, as well as confirmation that the patient has been contacted. If a specific appointment time is not available, then the confirmation must include some guidance as to when such should occur. If the referral is accepted, in most situations, the consulting physician is best suited to communicate the appointment date and time to both the referring physician and the patient. The consultant should also take the opportunity to recommend additional investigations which could be completed by the referring physician prior to the appointment.  If a timely appointment is unlikely, the consultant is encouraged to suggest alternative resources which may be more accessible.

In any case, both the office of the referring physician and the consultant should be willing to assist the patient with regards to any information regarding the status of the matter.

After first assessing the patient, the consultant may feel the need for further investigations. Under most circumstances, they should be arranged directly by the consultant, as it is the consultant who will be relying on this information to make recommendations in the patient’s care.  There are, however, circumstances where, in discussion with the patient, it may prove easier, from a distance or logistical point of view, for the investigations to be done closer to the patient’s residence.  If these arrangements can be expedited by the family physician, such approach is acceptable.  In any case, all efforts should be made to avoid any ambiguity as to how arrangements are being made and who will be responsible for the results and interpretation.  

3/10; Am 10/14; 11/20; 4/21

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