The Referral Process

Introduction
The practitioner needs to recognise when clients need referral, identify a range of health
care professionals/services and complementary health care practitioners and make an
appropriate referral.

Critical aspects include:

A. Referring to another practitioner

 Ability to communicate effectively
 Regard for patient confidentiality
 Demonstrated appreciation of the relative merits of the treatment options
available in regard to cost, benefit and efficiency of such procedures
 Knowledge of the profession's special characteristics
 Knowledge of health care professionals/services locally, nationally, and
internationally and of their relationship to other professions and organisations
 Consulting colleagues for special expertise
 Ability to write referrals, certificates and correspondence
 Demonstrated ability to formulate referral plans and arrange referrals

B. Receiving referrals from other practitioners

 Ability to communicate effectively
 Working within the parameters of treatment outlined by the recommending
practitioner
 Appropriate communication to the referring practitioner
 Regard for patient confidentiality

1
A. Referring to Another Practitioner

Step 1: Establishing the need for referral

As a therapist, there will be occasions when it will be necessary to send a client on to

another health practitioner for services that you are unable to provide, or to enhance the
services that you currently provide.

It is important to refer patients in a professional and appropriate manner. Providing the

specific information required to treat the client appropriately will ensure that other
practitioners understand what is required of them. (Central TAFE, WA, 2003)

Reasons for referring clients to other practitioners:

How do we know when to refer?

 Collect the information
 Be observant & vigilant
 Ongoing Treatment plans. These change and evolve as the client’s expectations
change
 Professional Boundaries – do not trespass areas where you do not have
appropriate qualifications. Know your skills, together with their limitations. Seek
assistance once you realise that you are outside of your depth, or you feel
uncomfortable.

From a legal perspective, “if it is deemed that that a practitioner is working beyond their
scope of practice as per their training and relevant association’s code of ethics, they
would be considered negligent.” (Central TAFE, WA, 2003)

2
Step 2: Identifying Medical & Counselling referral needs

Referring a client for medical care:

 Medical crisis situations - needs immediate referral to a doctor
 Blood Pressure – very high blood pressure, especially diastolic
 Other medical crisis include: Presence of abnormal growths or lumps; Intense
pain; Pain radiating; Infections; Presence of a “notifiable” disease e.g. Salmonella
or AIDS.
 Suspected stroke
 Pathology referrals

Notifiable diseases:
http://www.health.gov.au/internet/main/publishing.nsf/Content/cdna-
casedefinitions.htm/$FILE/casedef.pdf

Referring a client for counselling care:

Reasons for referral typically fall into two categories:
1. Where the patient is experiencing a personal crisis
2. Where the safety of the client is at risk

Examples:
 Need for ongoing support and counselling
 Relationship and family problems beyond the scope of the therapist
 Drug use or violence in the family
 Disclosure of physical or sexual abuse in a minor
 Client is exposed to verbal, physical or sexual abuse at home or in the
workplace
 Client has a personality disorder
 Patient threatens suicide or expresses a repeated wish to die
 Client threatens to hurt himself or herself, or is actively doing so
(Central TAFE, WA, 2003, p27)

Consider some symptoms of severe stress that would indicate a person is in crisis:

3
Step 3: Talking To Clients About Referral

“In any relationship, openness and honesty is essential. This is also true of the
practitioner/patient relationship.

When you are considering referral, or the patient requests this option, you should
discuss all aspects and implications with the patient before proceeding.” (Central TAFE, WA,
2003, p33)

How to inform your clients about the referral process:

 Be open & honest
 Explain what is involved
 Allow the patient to communicate his or her concerns or opinions freely
 Involve the patient in the process of need recognition and possible solutions
 Be professional, be objective and informed about possible referral sources. What
you don’t know, find out.
 Once the need for a referral has been agreed upon, give at least three alternatives
to choose from. For example counselling alternatives may include a free
government agency, a low-cost Church-run organisation or counsellors in private
practice, with appropriate expertise in the required area.

Central TAFE, Western Australia. 2003. Complementary & Alternative Therapies: Make Referrals to
other health care professionals when appropriate. Page 33

There is a balance between giving advice, and allowing the client to decide.

“Once the need for referral has been decided on, the practitioner provides information
that enables the patient to select the treatment s/he is most comfortable with. …
Remember that it may not always be the case that the practitioner’s preferred treatment
options are affordable to the patient. Whatever decision is made by the patient must
always be respected by the practitioner.” (Central TAFE, WA, 2003, p30)

Step 4: How To Identify Referral Sources

There are a wide range of health professionals and organisations available including the
services they offer.

Examples of options for referral

 Other complementary health professionals e.g.
 Chiropractors
 Physiotherapists
 Podiatrists
 Dieticians
 Social workers
 Medical practices e.g. general practitioners, mental health units, female health
services, mole clinics
 Support organisations e.g. AA (Alcoholics Anonymous), Hotlines such as domestic
violence, local church groups, child care centres, cancer support groups

4
  Midwife & birthing centres
 Advocacy services
 Refuges
 Crisis care centres
 Counselling agencies
 Recreational activities e.g. Tia chi, yoga, meditation

Collect information on these different referral sources.

You may consider about creating a referral information source, collecting business cards
and information booklets.

Step 5 Contacting & Communicating with referral sources.

Maintaining professionalism
 Conversation must be professional at all times
 If you know the practitioner personally, you need to maintain professional
boundaries when dealing with client issues
 Provide a clear understanding of technical terms and language
 Ethical principles& association guidelines are followed. Example: Patient
confidentiality must be protected at all times. Names and other identifying data
should never be used. Avoid mobile conversations in public.
 Respectful references to other professionals and/or practices. Example: avoid
derogatory remarks or facial expressions when talking about other practitioners
or their treatments.

Step 6 The Professional Referral Process

In the referral process, the therapist should provide specific information for the client to
be treated appropriately and the referral source understands what is required of them.

The Professional Referral Process

This can be done informally or formally. The advantages of the informal referral process
is that it can be done quickly, easily and can help build relationships with the referral
source. There are also disadvantages to the informal process, e.g. legal liability.

Formal referral procedures can take the form of a simple letter or complex reports.
Client consent (written) is need to send case notes (Client Files)to other practitioners.

Generally a letter written on the therapist’s practice letterhead is sufficient. A letter is

easier read if typed. The letter must be signed and dated. A copy of all written referrals
must be kept in the clients file.

Referral letters should contain the following:

 Information about the therapist’s practice (letterhead including name, address,
postcode & contact numbers)
 Address of referral source

5
  Name of practitioner client is being referred to (including title if appropriate)
 Brief introduction if no previous contact
 Description of client’s condition and relevant background (medical history, clinical
presentations)
 Thanks & appreciation of further contact & feedback
 Signature

Example of referral letter:

My Clinic
PO Box 15
Bruce
ACT 2617
myclinic@email.net
Ph: 62102030
Dr White
5 Main Street
Belconnen
ACT

12/8/10

Dear Dr White,

Re: Mary Jones

Thankyou for seeing Mary Jones. Mary has been receiving remedial massage over the
last 3 weeks to help relieve her headaches. The headaches were described by Mary on
her first visit as moderate and occurring daily. Her clinical presentation was consistent
with tension headaches. After 3 remedial massage treatments the headaches have
reduced in intensity and frequency. Mary now experiences mild headaches 1 – 2 times a
week.

The headaches generally present as Occipital and Frontal. Mary’s neck ROM, in flexion
and extension, appear mildly restricted.

In the last week, Mary has complained of feeling tired and sometimes experiencing nose
bleeds with her headaches. I have advised her to seek medical advice before continuing
massage treatment.

Yours Sincerely,

Fred Smith (Advanced Diploma of Remedial Massage)

6
Planning Workplace Documents requires the writer to:

 Identify audience and purpose

 Choose an appropriate format for the document
 Selecting relevant information
 Organising relevant information to suit the audience, purpose and content
 Produce a draft that states the purpose clearly, includes information relevant to
the reader, uses plain English and a format appropriate to the task
 Editing the draft – looks at sentence construction, paragraph construction,
spelling and punctuation, assesses words, sentences, form, structure and style for
appropriateness for the reader
 The completed document should follow accepted conventions of format and
layout to make the document readable

Factors affecting written communication include:

 Language: Vocabulary can be complex, simple or use jargon. Which is more
effective? Sentence length can be long or short. Which is more effective?
 Content
 Visual impact: Think about format, use of white space, graphics, font, colour &
texture.

Referral Letter
The important aspect of a referral letter is that clients are referred in an appropriate and
professional manner. Specific information is provided in a referral letter for the client to
be treated appropriately and the referral source understands what is required of them.

When contacting & communicating with referral sources:

 Identify the best possible referral source (telephone, email, internet, fax, letter
etc.)
 Maintain professionalism
 A professional will expect a clear understanding of medical terms & language
from a massage therapist or naturopath. They will also expect client
confidentiality and respectful references to other professionals and/or practices.

The referral process can be done informally or formally. The advantages of the informal
referral process is that it can be done quickly, easily and can help build relationships
with the referral source.

Note: When referring to a medical practitioner, it is recommended (not required) that

the following terms be replaced as indicated.
Refer -> recommend / Diagnosis -> assessment / Prognosis –> outcome

7
B. Receiving Referrals

There are a number of important protocols to be observed when receiving a referral

from another practitioner. Communication is very important. Let the practitioner know
that you appreciate their recommendation of the client to you and inform them of the
approximate duration of your intended course of treatment.

After The First Visit

It is a good practice to write a short note to the referring practitioner thanking them. It is
recommended that it be worded along the following lines:

My Clinic
PO Box 15
Bruce
ACT 2617
myclinic@email.net
Ph: 62102030
Dr White
5 Main Street
Belconnen
ACT

12/8/10

Dear Dr. White. Thank you for recommending Mrs. Jones for massage/naturopathy
treatment. I intend an initial course of 6 treatments/consultations and will keep you
advised of their progress.

Yours Sincerely, Fred Smith

pto

8
After The Initial Course of Treatment
Now write a very short report of the client’s progress to the referring practitioner. You
must gain client consent to do this. Keep it brief and to the point. Don’t supply complex
assessment and treatment details unless requested.

My Clinic
PO Box 15
Bruce
ACT 2617
myclinic@email.net
Ph: 62102030
Dr White
5 Main Street
Belconnen
ACT

3/9/10

Dear Dr. White. I have now seen Mrs Jones for 6 massage treatments.

Mrs Jones has responded well and reports a significant reduction in her symptoms. I
believe she would benefit from a further 3 treatments. Would you like her to consult
with you first?

Yours Sincerely, Fred Smith

My Clinic
PO Box 15
Bruce
ACT 2617
myclinic@email.net
Ph: 62102030
Dr White
5 Main Street
Belconnen
ACT

3/9/10

Dear Dr. White. I have now seen Mrs Jones for 6 naturopathy consultations.

Unfortunately she reports no significant change in her condition. I believe that further
treatments at this clinic are not required. I have therefore recommended Mrs Jones
make an appointment to see you.

Yours Sincerely, Fred Smith