A Rejected Referral: Like a Novel Without a Title

Today I had reason to review a medical chart of somebody I had never met before. They hadn’t been seen for a while. The most recent notation in the medical record was a fax from Cityside hospital’s urology practice. The fax, dated in October, stated that our clinic’s referral of this patient was rejected due to lack of information.

I had to search far back in the medical record for the referral. It was sent in January of this year, almost a year ago. The virtual fax contained about 25 pages of some brief notes and messages and a lot of laboratory reports.

Before opening that fax, I went into the lab section of the medical chart and there was a mildly elevated PSA result from January. This made me think that the reason for the referral was the elevated PSA, possibly indicating a significant prostate problem.

Quickly going through the 25 pages in that fax I did not see the PSA level. And the fax did not contain a headline to indicate the purpose of the referral.

Two things are striking about this incident. One is the lack of brevity in the referral our office sent out. The other is the lack of urgency on the part of the urology office in getting back to us questioning what the purpose of the referral was.

As far as our referral, I think it’s crucial to say what the main problem or question is. The other important thing is not to send too much information.. In our state just about every hospital laboratory uploads their results to a statewide database where any doctor can look up those results. This makes faxing lab test and x-rays almost unnecessary. Not all practices upload their office notes, though, so we have to be cognizant of that.

Everybody is pressured in today’s healthcare environment. There’s so much to do and so little time. Everywhere in our society, the attention span is dropping. I found it mind blowing that the urology office took nine or 10 months to raise the issue of what the referral was for, but I’m not completely surprised. They say that you have eight seconds to make a first impression when you meet somebody and in writing, everybody’s looking for a catchy headline. I mean, who would read a novel or even a short story with no title?

I think brevity in medical communications is a virtue. American healthcare today has all kinds of documentation requirements that don’t necessarily speed up the handling of medical issues. Unfortunately, the referral letter and the specialist response have almost gone by the wayside. They used to be valuable exchanges between colleagues, dictated, printed on fancy stationery and signed in ink. EMR’s don’t always accommodate for that type of exchange.

Let me go back and look at what I’ve written about referral letters before…