The Process of Medical Referral

Abstract

The purpose of this research was to develop a model of the complex process of medical referral, in which a physician consults with or refers a patient to a specialist. Fifty cases of referral were investigated by interviewing the referring physician, patient and specialist(s). Involved with the case at various points before and after the referral. Referrals were followed first in a southern Ontario city and, for comparison, in northwestern Ontario. Trust in the competence of specialist advisors was found to be the key component in understanding the process of referral. Referral in settings where there is mutual respect between referring physicians and consultants, particularly where they worked in close physical association, was contrasted with referral in settings where there is isolation of referring doctor from consultant, and a tendency towards breakdown in the process of the referral. Finally, when the activities and beliefs of patients as well as doctors were examined, patients were found to have a much greater influence on the initiation, process and outcome of referral than has been previously recognized.