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Consultations and referrals


Improving the referral-consultation process

Imaging and laboratory consultations


Diagnostic imaging and certain lab studies such as biopsies are an integral part of modern patient care.

The same principles apply when requesting these studies as for other consultations:

  • Share what you know.
  • State your expectations.
  • Determine the level of urgency.
  • What do you hope to determine with this investigation or test?
  • Does the specialist have any recommendations for helping with your patient's diagnosis or management?

Case: Hidden information
Middle age female patient undergoing CT scan

Background

A patient suffering from headache is sent for a CT scan to rule out an intracranial lesion. The report's conclusion specifically states there is no intracranial lesion.

Presence of a vague density in the right eye is mentioned in the body of the report.

The physician successfully treats the patient's migraine headaches. She later develops visual problems and the "vague density" is found to be a retinoblastoma.

Think about it

What might have prevented the delay in the diagnosis of the retinoblastoma?

Lessons learned

To prevent a similar occurrence:
  • The physician should read and act on the entire report.
  • Potentially significant but incidental findings could be noted in the conclusions of the report.
  • The physician should orally communicate critical results that require follow-up.
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