CPSO clarifies advice in two policies to bolster collaboration
Administrative burden is eating away at the time physicians want to spend with patients. In three articles, we address the efforts being made to put patients before paperwork, clarify the obligation of specialists and family physicians, and answer some FAQs about medical documentation.
Family physicians and specialists alike are facing significant challenges as clinical and administrative workloads increase, and pressure on the health system continues to rise.
Medical organizations across Canada have called for widespread system change to alleviate the pressure on physicians, but until these changes are realized, it has become even more important that both family doctors and specialists work together to support each other as they deliver quality care to Ontario patients.
To bolster collaboration, CPSO updated advice documents for two of its policies — Managing Tests and Transitions in Care. The updated advice documents clarify expectations and, in some instances, provide a fuller rationale for its expectations.
In its updated advice document for the Managing Tests policy, the College addresses responsibility for tests, stating “any physician who determines that a test is needed is responsible for ordering that test, tracking the results, and managing any follow-up stemming from that test. By ordering tests that they themselves have deemed necessary, physicians ensure that patient care is not unnecessarily delayed, and that their colleagues are not required to receive results or manage care that falls outside their scope of practice.”
In some instances, however, a specialist may ask the family physician or another specialist to arrange testing, for example, if a patient raises a concern unrelated to the consultation during the assessment or the physician identifies an incidental finding.
Physicians in the patient’s circle of care may be able to accept responsibility (i.e., tracking and/or follow-up) for a test ordered by another physician, but the receiving physician has to agree to accept responsibility for the test.
The updated advice document for the Transitions in Care policy states specialists can support referring physicians by accepting consultation requests, where possible, even if there are minor issues with the requests (e.g., incorrect or outdated referral forms).
The advice document goes on to state, "consultant physicians will need to provide appropriate follow-up care and handle any administrative work stemming from this care. Referring physicians may not have the expertise or resources needed to manage a patient’s specialized care.”
To help reduce the burden associated with unsuitable consultation requests, the advice document states that it is important for referring physicians to consider whether the patient’s condition is within the consultant’s scope of practice, whether the consultant is accepting patients and whether the consultant’s practice is accessible to the patient. By turning their minds to such questions prior to making a referral, referring physicians can foster a smoother referral process.
Dr. Rob Gratton, Council President, says he hopes the College’s clarifications encourage greater collaboration between family physicians and specialists. “A system as strained as the one we are all working in has everyone feeling overwhelmed. But we are each other’s best resource, and we need to work in the spirit of partnership for the good of our patients.”
