Abstract
BackgroundRelevant clinical information is often missing when a patient sees a specialist after being referred by another physician in the ambulatory setting. This can result in missed or delayed diagnoses, delayed treatment, unnecessary testing, and drug interactions. Residents’ attitudes toward providing clinical information at the time of referral and their perspectives toward training on referral skills are not clear. We sought to assess internal medicine residents’ attitudes toward and experiences with outpatient referrals.MethodsWe conducted a cross-sectional survey in October–December 2018 of all internal medicine interns and residents affiliated with a large, urban internal medicine residency program in New York, NY. We used a novel survey instrument that included 13 questions about attitudes toward and experiences with outpatient referrals. We used descriptive statistics to characterize the results.ResultsOverall, 122 of 132 residents participated (92% response rate). Respondents were approximately equally distributed across post-graduate years 1–3. Although 83% of residents reported that it is “always” important to provide the clinical reason for a referral, only 11% stated that they “always” provide a sufficient amount of clinical information for the consulting provider when making a referral. Only 9% of residents “strongly agree” that residency provides sufficient training in knowing when to refer patients, and only 8% “strongly agree” that residency provides sufficient training in what information to provide the consulting physician.ConclusionsThese results suggest a substantial discrepancy between the amount of information residents believe they should provide at the time of a referral and the amount they actually provide. Many residents report not receiving adequate training during residency on when to refer patients and what clinical information to provide at the time of referral. Improvements to medical education regarding outpatient referrals are urgently needed.
Highlights
Relevant clinical information is often missing when a patient sees a specialist after being referred by another physician in the ambulatory setting
The majority (64%) intended to pursue a medical sub-specialty fellowship, 13% intended to pursue a career in hospital medicine, and 9% intended to pursue a career in primary care
The majority of residents (71%) served as primary care providers at the resident-attending practice affiliated with the academic medical center, 15% practiced at the smaller branch of that practice, and 13% practiced at the federally-qualified health center
Summary
Relevant clinical information is often missing when a patient sees a specialist after being referred by another physician in the ambulatory setting. This can result in missed or delayed diagnoses, delayed treatment, unnecessary testing, and drug interactions. Multiple reasons have been proposed for insufficient information being conveyed by the referring PCP to the consulting specialist, including undervaluing of and inadequate compensation for provider communication, which can be a time-consuming endeavor [4, 5], as well as lack of standardization of referral procedures [6], and inadequate appointment times and support staff [3]. We define a PCP as a physician practicing general internal medicine in the outpatient setting It is not clear how or when patterns of insufficient communication begin. There is a paucity of research evaluating the effects of internal medicine
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