Effective Communication with Referrers

Whether you are working within a government organisation or a private practice, a varying component of your referrals are going to be directed to you from colleagues and other medical practitioners. In the case of hospitals, there will be protocols in place about appropriate reporting content and frequency.

But what about in private practice?

How often do you write?
What information do they want?
What information do they not want?
How do they want to be communicated with?
How technical do they understand?

Step 1. Know Your Referrers

In essence, I would suggest you do what we did. Firstly contact you main 5-10 referrers in person. For the most part this will require an appointment, but in our case in a small country town, over the period of a few months socially worked fine. If you don't know who your main referrers are, then you need to implement a simple 'source of referral' tagging system for all your new clients. Best to have it on your 'New Clients Details' form and train your admin staff to check visually, that it has been correctly completed for all new clients. Categories might include; GP (who), Specialist (who), Friend (who), Walk by, Past Client, Advert (which one), Presentation (which one).

Step 2. Determine Referrer's Preferences

While your options here may seem simple, you need to dig deeper and at the same time consider your broader situation.

Obvious options are;

Phone call
Snail mail
Email

but there are broader considerations to take into account.

For example;

Personal preferences
Legal requirements
Data security & storage

Step 3. What to Write

Here is what I have found so far after talking with our referrers and experience over the past few years. Modify this with your own experience and referrer preferences.

(i) Size Matters

Size does matter! If your reports are going over a page, it is perceived mostly as 'too much information' and put aside for a quieter period of time by the busy practitioner. In other words, you are making their life harder and subconsciously they will procrastinate. Unlike medical reports where the practitioner is being paid by the page, we are paid by the report, so keep it concise and less that a page.

(ii) Relevance

If the referrer you are writing to is already familiar with the client and their problem (i.e. they referred the client to you in the first place), you don't need to include everything they already know. Even resist the urge to summaries know information. If the referrer is familiar with the client, but not the specific problem, then elaborate on that aspect only.

(iii) Content & Comprehension

Order your thoughts in a logical format (SOAPIER or similar is a good example).
Avoid technically professional terms (e.g. grade 5 thrust) and anacronyms (AROM) .

Use a word editor to spell check and consider tools like Grammarly and Hemmingway to improve written comprehension.

(iv) Recommendations

You are a professional whose opinion is important within your scope of practice. It is important that you outline what direction and type of management you recommend, based upon your assessment. Also identify issues that might impact upon the success of your client's treatment.

Apparently we tend to remember the first and last thing people say, and letters are similar. Have your important information at the start and end of your letters. Plus some readers are 'bottom feeders,' meaning they skip to the bottom of a communication to quickly reach the summary. Make sure important information is repeated or found there.

Okay, so we now have a better idea about what to write (remember, filter these comments with the awareness of what your referrers prefer), but how are you going to deliver this information and what does it matter.

Step 4. How to Deliver Your Communications

Option 1. Phone Call

The phone call is great for a quick 'update of status,' if something of significance has occurred since your last written report, that has a degree of urgency and writing will take too long or get there too late. While historically this has been a preferred option, it would seem times are a changing. Firstly, practitioners are busy and taking a phone call interrupts their planned workflow e.g. consulting with a client or having set aside time to deal with a specific issue. Secondly, if the issue is important, then you will need to write a report anyway because thirdly, if it isn't written, it didn't happen and this relates to accountability.

In summary, while a phone call has been a useful tool in the past, with different expectations and reporting requirements, usage is now more limited.

Option 2. Snail Mail

Without doubt, snail mail was a very common form of communication, but you only have to listen to Australia Post to know that less and less letters are being written. However, if you don't have a specific email address, then a letter directed to the Workers' Compensation Department, QBE .... will get to the right section in the early stages of a claim, before a claim number has been assigned (often taking 6+ weeks).

To improve efficiency it helps to work to a mail template. This ensures all practitioners within the same clinic are covering all relevant headings and sticking to a common visual framework. By structuring the mail template, you can also ensure requirements of 3 parties payers are covered and in this way achieving the dual aims of replying to referrer and submitting a required 3 party report (e.g. insurance company).

For example, if you decide to treat worker's compensation clients, and be paid for your reports, you need to cover certain specifics as part of their treatment plan guidelines;

Client details block (name, DOA, Employer)

Examination findings (subjective, objective, questionnaire/outcome measures)

Provisional diagnosis

Treatment (goals, proposed number of treatments, time period of treatment, treatment types)

I recommend reports to insurers be written within 2-3 treatment sessions. By this time you will have completed all your assessments, had time to gauge the effectiveness of your interventions, and understand if there are other issues that need to be addressed e.g medication review, imaging considerations. The primary letter will be addressed to the referrer (courtesy), but the cc will go to the insurer (payer). In this way, the insurer is also going to know what your treatment plans are, so you won't receive a 'please explain' request, making the whole system more efficient.

Sending sensitive (content or time) information through Australia Post or courier is best done with personalised collection requirements (see Secure Collect) attributes rather than just a stamp.

Option 3. Electronic Letter

The electronic letter is basically the same as a snail mail, just converted to an electronic format. While mail can be lost, stolen or eaten, the problems with an E-letter are restricted to lost/junked or stolen.

However, the issue of data theft is present and increasing. For this reason and because you have responsibilities of data protection, information that is sent over the internet or copper wires should be protected, and this includes faxes.

Once you have created your letter (using a template), you have a couple of sending options to improve security. One is to convert your letter into a pdf format and encrypt with a password. You can then send the pdf attached to an email and physically contact the receiver, letting them know the password to unlock the document. Great for medicolegal documents, however it is not practical for GPs or insurers.

For GPs, a good option is joining a secure network provider like Health Link. Essentially for an annual fee you receive a secure mailbox/address with a send/receive function. From your provided desktop app, you can send letters to other specific mailboxes (e.g. your GP network). When they receive your letter (they can also send you referrals), you receive a notification acknowledging receipt and opening of your letter. For GPs, this program integrates with their practice management software and places your letter, automatically then into the client's medical file. Secure yes, simple, not so from our experience so far, but the best that is available at present.

Getting the information to insurers via a secure method is harder. Snail mail from Esperance to Perth is at least a week. Consistent and reliable email addresses and secure network systems don't exist that I am aware of, so we use the fax as these numbers stay current for each company. Ideally they would institue a secure network with a central clearing hub into which practices could access and send reports. Ideally.

As always, I look forward to hearing of your thoughts and experiences.

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