Abstract
To define the process of outpatient consultation, the authors conducted a prospective study of 716 consecutive outpatient consultations in a university-based primary care internal medicine practice. The overall consultation rate was 11.9 per 100 patient visits, with 78% of the referrals to other physicians and 22% to non-physician specialists. Consultation rates and patterns of referral varied little between physicians with different levels of experience. Eighteen per cent of the consultations resulted in a no-show by the patient to the consultant. Referring physicians received communications from the consultants 80.5% of the time when appointments were kept. By multivariate regression two variables were shown to be most important in determining the internist’s overall satisfaction: 1) how well the consultant aided the internist in his ongoing management of the patient’s problem, and 2) how well specific questions were addressed by the specialist. Other statistically significant variables were the clarity and promptness of the consultant’s reply, the educational value of the consultation, and specific management recommendations made by the consultant. To improve the consultation process no-shows must be minimized, communication from the consultant maximized, and the interaction between the internist and the consultant bolstered.
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References
Metcalfe DHH, Sischy D. Patterns of referral from family practice. NY State J Med 1973;73:1690–4
Brock C. Consultation and referral patterns of family physicians. J Fam Pract 1977;4:1129–34
Hines RM, Curry DJ. The consultation process and physician satisfaction: review of referral patterns in three urban family practice units. Can Med Assoc J 1978;118:1065–73
Ruane TJ. Consultation and referral in a Vermont family practice: a study of utilization, specialty distribution and outcome. J Fam Pract 1979;5:1037–40
Curry RW, Crandall LA, Coggins WJ. The referral process: a study of one method of improving communication between rural practitioners and consultants. J Fam Pract 1980;10:287–91
Cummins RO, Smith RW, Inui TS. Communication failure in primary care: failure of consultants to provide follow-up information. JAMA 1980;243:1650–2
Carson NE. The referral process. Med J Aust 1982;1:180–2
Klein LE, Moore RD, Levine DM, Kirby S. Effectiveness of medical consultation. J Med Educ 1983;58:149–51
Lee T, Pappius EM, Goldmann L. Impact of inter-physician communication on the effectiveness of medical consultations. Am J Med 1983;74:106–12
Horowitz RI, Henes CG, Horowitz SM. Developing strategies for improving the diagnostic and management efficacy of medical consultations. J Chronic Dis 1983;36:213–8
Perlman LV, Kruskall MS, Rosenzweig D, Kaufman J. Process and outcome in medical consultations: evaluation on a pulmonary service. Postgrad Med 1975;57:111–5
Manning AP, Long TT, Tyor MP. Analysis of patients referred to a gastroenterologist practicing in a community hospital. Gastroenterology 1980;79:566–70
MacKenzie TB, Popkin MK, Callies AL, et al. The effectiveness of cardiology consultation: concordance with diagnostic and drug recommendations. Chest 1981;79:16–22
Rudd P, Siegler M, Byyny RL. Perioperative diabetic consultation: a plea for improved training. J Med Educ 1978;53:590–6
McPhee SJ, Lo B, Saika GY, Meltzer R. How good is communication between primary care physicians and subspecialty consultants? Arch Intern Med 1984;144:1265–8
SAS User’s Guide, 1979 Edition. Cary, NC: SAS Institute Inc., 1979
Robert Wood Johnson Foundation Special Report. Medical Practice in the United States. 1981:1–96
Bigby J, Pappius E, Cook EF, Goldman L. Medical consequences of missed appointments. Arch Intern Med 1984;144:1163–6
Lowenstein SR, Iezzoni LI, Moskowitz MA. Prospective payment for physician services: impact on medical consultation practices. JAMA 1985, 254:2633–7
Schaffer WA, Holloman FC. Consultation and referral between physicians in new medical practice environments. Ann Intern Med 1985;103:600–5
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Received from the Section of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, and Health Care Research Unit, Section of General Internal Medicine and the Evans Memorial Department of Clinical Research and Medicine, Boston University Medical Center, Boston, Massachusetts.
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Byrd, J.C., Moskowitz, M.A. Outpatient consultation. J Gen Intern Med 2, 93–98 (1987). https://doi.org/10.1007/BF02596304
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DOI: https://doi.org/10.1007/BF02596304