Serial analysis of referral letters – content

It is suggested that you look in detail at 10 consecutive referral letters you have written. The person to whom you have referred will be meeting the patient for the first time (usually) and a full patient history is important. Check the referral letters for the details suggested on this template link and if appropriate suggest changes. You may wish to include your reflections on the issues identified and learning points on MARS, and include your analysis as additional supporting documentation.

Example

Reason for referral History of complaint Medication history, allergies Examination findings, tests performed Relevant psychosocial history Past medical history
      Absent    
    Absent      
  Absent     N/A Absent
    Absent      
           
    Absent Absent N/A  
           
           
  Absent     Absent Absent
    Absent      

Issues identified

Serial analysis of referral letters content

I had always thought that I wrote extensive referral letters with all relevant details. I examined 10 referrals six months after I had written them and I was quite surprised at some of the detail I had omitted. Two of the referral letters did not contain the history of the complaint despite it being documented on the computer. In the four letters without medication history recorded only one patient was taking medication. I had not mentioned examination findings twice – in both cases negative examination findings and test results were documented. Only one patient did not have relevant psychosocial history documented (recent death of spouse) and in two cases I omitted relevant past medical history

Learning points

I was surprised to note that only 3 of the 10 letters met all the criteria and I must admit that there was one letter that if I had received it would not have told me enough detail to help me in the consultation. This analysis has helped me look critically at this important aspect of my practice and I have made the following changes:-

  • I have printed off a card with the 6 criteria and stuck it to the front of my Dictaphone as an aide memoir
  • I have changed the way in which I dictate my referrals – I used to let them pile up and do them toward the end of the week, I now dictate at the end of surgery. This actually is less stressful as there at most one or two to dictate and the patient is fresh in my mind.

I intend to repeat this exercise in a year’s time to ensure the changes I have made are long lasting.


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