Individual referral letter analysis

This template allows you to demonstrate good clinical care with regard to referral; you can use it to show an early diagnosis and appropriate referral or a case which you were involved in using investigations to come to a diagnosis requiring referral. It is obviously important that you anonymise the letter.  You may wish to document your reflections on what the referral demonstrates as part of the online appraisal form 3 template.

Referral letters analysis should include:

  • A copy of referral letter
  • What does this referral demonstrate?

Example 1

Copy of referral letter

I should be very grateful if you would see this gentleman at your earliest convenience.  He is 67 years old has no significant past medical history, takes no medication and has no allergies. He presented today with a 2 day history of fresh rectal bleeding on defecating. He has never experienced this before and his bowels are normal. He has lost no weight and is physically active playing tennis and walking his dog. He is a lifelong non smoker and lives with his wife.

On examination abdominal palpation is normal, on p.r. I think there is a hard mass at the tip of my finger.

I am concerned he may have a rectal carcinoma. I have told Mr X that he will need further tests as I am concerned that he may have an underlying reason for his rectal bleeding, he asked me about cancer and I said that there is a chance that this might be the case. I have sent off routine bloods and asked for a copy to be forwarded to you.

Many thanks

What does this referral demonstrate?

This gentleman was seen within 10 days of my letter (and phone call). Sigmoidoscopy revealed a rectal carcinoma he underwent a low anterior resection and the histology revealed a Dukes A carcinoma. This referral demonstrates appropriate urgent referral and an early diagnosis of a cancer. This gentleman presented with a short history of rectal bleeding and I examined appropriately, referred urgently and included all relevant details in the letter. The case illustrates appropriate secondary care action also.

Example 2

Copy of referral letter

Individual referral letter analysis

Many thanks for your help with this 72 year old lady who appears to have myeloma. She presented 4 weeks ago with sudden severe low back pain and immobility. I suspected an osteoporotic vertebral fracture and subsequent x- ray revealed wedging of L1. Initial investigations revealed a mild normocytic anaemia with a grossly elevated plasma viscosity of 2.01. I then ordered plasma electrophoresis and Bence Jones protein, the electrophoresis shows a band in IGA and positive Bence Jones.

She has a past history of hypertension and had a cholecystectomy in 1985

She takes atenolol 50mg and felodipine 2.5mg for her hypertension and is on dihydrocodine for her pain. I have discussed the diagnosis with her. I should be grateful for you help with management.

What does this referral demonstrate?

I used investigations wisely here to arrive at a diagnosis quickly; I recognised the initial presentation as a vertebral fracture and used investigations to diagnose the underlying myeloma. The referral letter contains good information and the relevant test results.


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