1 Jun 2024
The process of referring a client’s animal into the hands of another clinician can be fraught with complications. But, as so often in life, good communication is key to success…
Helen Swift
Job Title
Image @ iStock.com /cienpies
From time to time we all need to refer cases – even if we are working to an advanced level in our own practice.
Reasons for this will be variable – maybe the client has insisted on seeing a specialist, maybe the referral centre has a piece of equipment or a skillset you don’t have, or maybe you are so booked up with procedures that you need to find someone else to help you out. There is always a case you get completely stuck on and just need a fresh pair of eyes.
Whatever the reason, it always helps if you have a good relationship with the referral centre(s) that you are going to use most frequently. In general practice, I find that you will always go that bit further out of your way for the client who is a polite, thoughtful, regular visitor, and it is logical that the same goes for the relationship between the general practitioner and referral clinic. So, how can we try to build and maintain this relationship?
Get to know your local referral centres. Most will run CPD – often free evening ones (bonus points for good food offerings). Many will also run local lunchtime or evening CPD for individual practices.
Meeting the clinicians you are going to be referring to is incredibly useful as you can reassure your clients and it helps build a good relationship if you need to ask advice.
• Ask for advice. Clinicians are very happy to respond to advice queries, whether this be prior to a referral or to help you manage cases in house.
If a client cannot attend the referral centre, you can still get help to manage the case in house. It may also be that the patient does not actually need referral at that stage, and talking it through with the clinician can avoid an unnecessary trip and frustrated client.
• Give a clear, concise history and set expectations for what you and your client want from the referral. Send any history, results or images in a timely manner so they can be reviewed by the clinician in advance.
Karla Borland, clinical lead and head of anaesthesia at Lumbry Park Referrals, said: “If you are calling the clinic with an emergency referral, have the key five points of the case to hand to aid discussion and decision making.
“For example, if the patient is anaemic, have the pertinent blood results written down. It will make the conversation so much smoother and allow the clinician to give you the most accurate response.”
• If it is a written referral, as well as sending a full history, give a bullet point summary of the case as well, such as:
Let the client know about the likely cost of treatment in advance. All referral centres are able to give you an estimate if you talk to them, and will be able to let you know the procedure for direct insurance claims if appropriate. Some centres will have this information online and may have fixed costs for certain procedures.
We all know that discussion of costs can be difficult at times, but it is so much easier to advise owners beforehand than deal with a complaint afterwards (and it is not fair on the referral centre, either). The discussion of cost will sometimes tie in with a discussion around the level of specialisation (see later), as in some cases the cost may determine the option the client chooses.
Equally, for the referral centre to foster a great relationship with the referring clinician, make the process of referral as simple as possible. If an online form needs to be completed, make sure it all works smoothly and that any extra information can be emailed rather than having to be uploaded (for those of us less adept at the technology).
Often, the general practitioner is very invested in the case they are referring. It might be a long-standing patient or just a very interesting case. Updates on the case, even if only very brief initially, are always appreciated so we know what is happening. However, if a patient is discharged, please let us know and send a copy of the discharge notes – even if a full referral report takes a few days more.
Who should we refer to? Differences exist in the level of qualification attained by vets accepting referrals. Who you decide to refer your patient to may depend on other factors, including cost, distance and availability.
However, it is important that your client understands who they are being referred to and why – especially if subsequently a complication occurs following their pet’s treatment.
“The key to a successful referral relationship for the GP vet clinic, referral centre and client is communication. Without that, the relationship falls apart, but if we communicate clearly, concisely and effectively, we will have a good outcome.”
So, how do we address this with clients when discussing where to take their pet? Most clients are used to levels of specialisation within the human medical world, so making comparisons can be helpful at times. If no constraints exist with budget, travelling and so on, then of course we can recommend they see an RCVS specialist. They will be seeing the person with the most advanced level of qualification and knowledge in their subject area.
As mentioned before, many other factors are often at play. Very often, some restriction on cost will exist, or the owner cannot travel far – or at all. In this circumstance we can explain that while the specialist is therefore not accessible, we have alternatives available.
An advanced practitioner has advanced knowledge and training in their particular subject area. Occasions may arise where they need to refer on to a specialist, but would often be able to discuss this in advance. Increasingly, peripatetic services are available, and this may be a deciding factor for an owner if they can be seen at least initially in their home practice.
If a patient is seen initially by a certificate holder in the practice, it is important that owner is made aware this is a vet with a special interest, rather than a specialist, and that they may need further referral.
Of course, the qualification level of the clinician is one factor, but another is the type of clinic they are working from. The client should again be made aware of factors such as whether overnight hospitalisation is available on site.
Equally, some conditions may require clinicians from different disciplines – maybe it’s not clear if the case is neurological or medical, for example, so you need to have both available. The patient may have comorbidities that would, for example, make anaesthesia more risky and need an anaesthesia team available. Again, being clear when you explain to the client why you recommend a particular service is key. They can decline to use that service and go for an alternative if they wish, but they do so in full possession of the facts.
What level of “specialisation” is needed will be very much case dependent, but the key is to communicate clearly to the client why you are recommending a particular clinician or referral centre and, if appropriate, what the alternatives are. A simple example may be cruciate surgery. The options could be:
There is, of course, more detail to discuss with this, but we should give clients the chance to choose what they feel is the best option for them and their pet.
In writing this article, as mentioned briefly in the introduction, it is clear that the key to a successful referral relationship for the GP vet clinic, referral centre and client is communication. Without that, the relationship falls apart, but if we communicate clearly, concisely and effectively, we will have a good outcome.
If the communication is poor then we may end up in a situation where the client is unhappy, the referral clinician frustrated and the GP vet unsatisfied. Many CPD providers offer training on communication. SPVS members can access relevant content through the Thriving in Practice Hub on our website or join us at congress in January 2025.
