Unclear consultation

Activity summary

This text case describes a situation in which an unclear consultation letter and process could result in a poor outcome for a young patient. The facilitation questions and suggestions to faculty focus on helping learners to understand the responsibilities of referring and consulting physicians, and to understand which information is important in consultation reports.

Case scenario

You are seeing a 10-year-old child with her mother in your office. You last saw the patient 3 months earlier when she was experiencing recurrent constipation and abdominal pain. You referred her to a pediatrician. The patient and her mother have since seen the pediatrician, and the mother is now following the pediatrician’s recommendation to follow up with you. 

The mother is quite concerned because her daughter’s symptoms are still quite bothersome, and she is not sure if she is giving her the medications prescribed by the pediatrician correctly, or if they are even working. Furthermore, the pediatrician raised the possibility of a serious illness. 

You retrieve the pediatrician’s consultation report. The treatment plan set out in the report is as follows: 

"I've told Mrs. Jones that Jenny first has to undergo an oral cleanout, which she should then follow with a meaningful trial of daily laxative. I've given her a prescription and advised her to titrate to effect. She'll need to be seen by you in a month or so to make sure all is good. This problem is most likely functional, but if needed, we'll order some further investigations to rule out less common pathologies. 

Thank you for your kind referral."

Facilitation questions

1. What details should typically be included in a consultation report? Are there any details you think are missing from the pediatrician’s report?
2. How might referring and consulting physicians better ensure clear and effective communication?
3. Who is responsible for the follow-up of patients seen in consultation? How could this be better defined in this situation?

Suggestions to faculty

Have the learners write the referral letter that might have accompanied the request for a consultation.

This text case can also be used to discuss the CMPA Good practices, “Physician-patient: Informed discharge”, “Physician-patient: Documentation and record keeping” and “The healthcare system: Medication safety”. For example, how could the pediatrician have ensured Mrs. Jones understood his instructions?

DISCLAIMER: The information contained in this learning material is for general educational purposes only and is not intended to provide specific professional medical or legal advice, nor to constitute a "standard of care" for Canadian healthcare professionals. The use of CMPA learning resources is subject to the foregoing as well as the CMPA's Terms of Use.