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by Sharon Koob, RN, BSBA, CPHRM, ARM
Princeton Insurance Healthcare Risk Consultant
Printable Version of this Article
The American Association of Family Physicians (AAFP) has specifically defined the difference between the terms “consultation,” “referral,” and “transfer of care” because these terms have been used interchangeably.[i] The words consultation and referral seem to be transposed more frequently. Confusion over the use and meaning of common terms can lead to misunderstanding. We are all aware of the recent push taken by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and all other leading quality of care organizations to remove, restrict, or minimize the use of confusing abbreviations. Confusing terms can lead to medical error as easily as confusing abbreviations.
First, it is important to identify the differences in meaning among these three terms. The AAFP defines consultation as:
a request from one physician to another for an advisory opinion. The consultant performs the requested service and makes written recommendations regarding diagnosis and treatment to the requesting physician. The requesting physician utilizes the consultant’s opinion combined with his own professional judgment and other considerations (e.g. patient preferences, other consultations, family concerns, comorbidities) to provide treatment for the patient.
This description is consistent with the meaning of consultation as defined in the Current Procedural Terminology (CPT) manual.
The AAFP defines referral as:
a request from one physician to another to assume responsibility for management of one or more of a patient’s specified problems. This may be for a specified period of time, until the problem(s)’ resolution, or on an ongoing basis. This represents a temporary or partial transfer of care to another physician for a particular condition. It is the responsibility of the physician accepting the referral to maintain appropriate and timely communication with the referring physician and to seek approval from the referring physician for treating or referring the patient for any other condition that is not part of the original referral.
Finally, the AAFP defines transfer of care as:
a transfer of care occurs when one physician turns over responsibility for the comprehensive care of a patient to another physician. The transfer may be initiated by either the patient or by the patient’s physician, and it may be either permanent or for a limited period of time until the patient’s condition improves or resolves. When initiated by the patient’s physician, the transferring physician should explicitly inform the patient of the transfer, and assist the patient with timely transfer of care consistent with local practice.[ii]
If these definitions are used consistently, there should be no confusion whether a physician will follow a patient or not when a consult is ordered. A consult will require a written report, a phone discussion in urgent situations, and no more. Yet some physicians do find themselves in practice situations which seem to limit their control over the situation. Managed care plans with continually changing lists of providers which the patients choose from lead to frustration in the primary care office; and the permission slip which gets the patient into another other doctor’s office is called a “referral” form. A patient’s primary physician may not even know the physician the patient will be going to see for the ordered consult.
Continue to pg. 2 
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