Volume 3 - Issue 4

The Consultation Room

Prof. Dr. CMK. Reddy

General & Vascular Surgeon, Halsted Surgical Clinic, Chennai, Tamilnadu, India

Chapter 46: Referred by a Doctor

It's important to extend due courtesies to patients referred by a Doctor and the patient appreciates that because of that, some extra attention was given. This is not to say proper attention need not be given to other patients, but such gestures would keep the referring Doctor in 'good humor', though ultimate treatment may not change.

It's equally important that a proper reply is sent to the referring Doctor, giving details about the investigations done and the probable diagnosis, including future plans for further studies, if necessary. If surgery is advised, it's nature, risks, preop preparations and other relevant facts, including any nonsurgical options available, to be indicated.

For example, if surgery (stripping) of varicose veins is planned, the other options, such as laser or radiofrequency ablation or foam sclerotherapy, have to be mentioned. Similarly for patient requiring inguinal hernia repair, the pros and cons of open vs laparoscopic approach have to be explained.

This will provide necessary information for proper counseling of patient by the referring (family) Doctor, in whom he may have more confidence. Besides being educative, the referring Doctor also appreciates that he's kept in the 'loop' of the overall management of the patient.

Alternately, if a letter can't be prepared in time, before the patient leaves the office, it may be mailed as soon as possible, or the referring Doctor may be briefed about the details on phone, by the consultant. At the time of discharge from the hospital after surgery, a detailed discharge summary, indicating the procedure and postoperative pracautions, has to be given to the patient.

It's very important and ethical that the referring Doctor's name is included in the discharge summary, which will be appreciated by him, as well as the patient.

Chapter 47: Referral to another consultant

If you don't want the patient go through the ordeal of fixing appointment with another consultant, it's better either the Doctor himself or his secretary fixes the appointment and gives a letter of reference. This will make the matter easy for the patient, who may be already troubled with his ailment and concerned about the cost and outcome.

If the patient has to be seen by more than one specialist, the primary Doctor should liaison between them and make them come to a 'considered' conclusion. For want of such a coordinator, there should be no communication gap, delaying the decision making or carrying out an investigation by one consultant, which is felt not needed by another specialist.

We should realize the importance of communication or conference between the various consultants attending on a patient, to avoid 'catchy' headlines in news papers: 'Doctors differ and patients suffer'.

Same procedure may be followed, if the patient requested for a second opinion or the Doctor himself decided to get a second opinion, before planning a major procedure or for a patient, who is critically ill.

The Consultation Room

Chapter 48: To get another letter from family Doctor

Some patients initially referred to you by his family Doctor for some surgery, want to continue seeing you, even after the immediate postop period, for all their ailments. In all fairness, after the surgical matter is over, the patient should be advised go back to his family Doctor, for any other problem (unrelated to the operation).

If the patient insists on seeing you in future, then he should be asked to get another letter of reference from his family Doctor, so that the Doctor won't think that you had 'taken away' the patient from him. Otherwise, there is a risk that the particular Doctor may not refer another patient to you, a justified decision from his angle.

The Consultation Room

Chapter 49: Collection of fees

To give a good professional look, it's better the Doctor doesn't collect fees directly from the patient. As the patient walks out of Doctor's chamber, the secretary or receptionist may be instructed through intercom, the amount to be collected. Even counting the money given by the patient in his presence (to verify if it's correct), doesn't give a 'healthy' feeling to both, but this is an inevitable embarrassment, if the Doctor has no assistance.

There is a possibility of the patient paying less (by oversight) or with counterfeit notes. The Doctor has to monitor closely, if the fees is collected by the secretary/receptionist, to avoid any fraud by them, of collecting more from the patient, which will go unaccounted.

This can happen even if a Receipt is given for the amount paid; the counterfoil will show lesser amount than the actual Receipt given to the patient! It'd be nice to provide facility to accept payment by a credit card, the swiping equipment may be easily installed in any office, but the money transfer into our account has to be closely monitored, to ensure proper functioning of the gadget.

If you are in Govt service and planning to admit a patient in your Unit (in Govt Hospital) for treatment, for financial reasons, it's ethical that no money, not even the consultation fees is accepted from him, on moral grounds.

The Consultation Room

"Wake up Mr. Jones!
It's time for your sleeping pill."

Chapter 50: Patient left without paying fees

The same procedure of noting in the record, can be followed, if the patient leaves your office, without paying the fees (most of the time by mistake, but occasionally intentional) or requests to allow him pay it at the time of his next visit. This is very useful, even if the patient reports to you for some other problem, months or years later.

Some extra fees (as fine) is collected, if it's proved that he deliberately avoided paying the fees last time, especially if he is a habitual 'offender'. Sometimes patient argues that he had paid the fees during his previous visit, but the secretary should convince him that there's no appeal against the personal notation by the Doctor.

As a matter of additional precaution, such patients are allowed into the Doctor's chamber, only after clearing the 'arrears'. If we waive fees for a patient, it's a gesture or goodwill on some special consideration, but not if they behave smart and want to take us for a 'ride'.

The Consultation Room

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