REFERRAL LETTERS TO THE SPECIALISTS: What you need to know

Hello everyone! I hope you are enjoying the new year already and have been increasing your child health knowledge and intelligence. If not, kindly head over to ATP Facebook Groups and begin to read up.

Today I want to address this issue of referral letters. I do a get a lot of inbox messages asking me for referral letters to see specialists in the Teaching Hospitals. I know that I do advise a lot for parents and carers of children to take some cases to the Specialists so it is therefore not surprising when I get such requests.

 I realized that many perhaps do not know how to go about the process of getting such referral letters and think you “must know someone” to get a referral letter or be seen in a Teaching Hospital! That’s not true! In fact it is so easy to get a referral letter to see a specialist or consultant at their clinics in a Teaching Hospital.

First of all for those who have not read my memo about the Nigerian Health System – the three cadre of health services, you need to do so first to really understand the background for today’s memo.

Let me just give a little recap by saying that the Teaching Hospitals or Federal Medical Centres are the Tertiary level of health care in Nigeria. They are the apex of care and most advanced and sophisticated services. Most of the superspecialists are in the Teaching hospitals.

However, you don’t just walk into Teaching Hospitals ideally for care. They are often designated to see only 2 categories of patients :

1. Emergency Cases

2. Referred Cases from other doctors and health care professionals from the lower hospitals.

It important to note that emergency cases are taken straight to the Accident and Emergency Centres/Rooms – could be for adults and children separately. Emergency cases DO NOT NEED A REFERRAL LETTER to be seen at the Emergency Rooms. Emergency means life threatening conditions that require IMMEDIATE attention or life would be lost. URGENT cases can also be seen in the A/E. Urgent cases need attention at least within 24 hours to avoid becoming an emergency! Please don’t go to Emergency Room for minor cases. In Emergency Rooms, you are not attended to according to First Come, First Serve!! Not at all! What is done is called TRIAGE and the MOST SEVERE CASES would be attended first to avoid loss of life! So don’t fight the A/E staff if they keep you waiting for hours. Most likely you should not have been there in the first place!

The rest of patients seen at Teaching Hospitals who are not Emergency Cases MUST BE REFERRED! That is why you need a REFERRAL LETTER to a specific consultant or clinic. So how do you get a referral letter?

1. GENERAL PRACTITIONER/FAMILY DOCTOR

The doctor who has been seeing the child should be the one writing a referral letter. It should be a free service so you don’t have to pay for the letter as long as you have been known to the doctor or registered under the practice. Most times, he should be the one initiating the referral. However if another Profesional suggested the referral, your regular family doctor or GP can still write the referral letter for you.

2. PRIMARY/SECONDARY HOSPITALS

You can also get a referral letter from the General Hospitals and sometimes from comprehensive primary health centres that have doctors. You can always walk in to these hospitals and request a referral letter if suggested by another professional. They will of course verify if there is justification for the referral in the first place.

3. GENERAL OUTPATIENT CLINICS at the Teaching Hospitals

Due to Nigerian peculiar situation, most of the Teaching Hospitals also operate a General Outpatient Clinic where you can WALK IN without a referral to be seen by the Family Physicians. If you have such in your Teaching Hospital, then you can also get a Referral letter from the doctors working at the General Outpatient Department or Clinics to the Specialists Clinics. Kindly note that only the General Outpatient can be accessed without a referral letter in a Teaching Hospital setting. However they can assist you with referral letter to the specialists if not too busy. It is actually easier to get it from your private doctors or at the General hospitals.

Occasionally for some that wander into the Children’s Emergency room and deemed not to have emergency cases, if not so busy, the casualty staff may also redirect you to the appropriate clinics and write a referral letter. However, do not go to the Children’s Emergency room or A/E just to get a referral letter. They are usually too busy and can keep you for a whole day if it is quite hectic. You are better off going to get it at General Outpatient or General Hospitals.

Finally, ideally only a doctor who has seen a child should do the referral letter. So asking me to do a referral letter to a child I have not seen is inappropriate. This is because ideally referral should be a two-way cycle with the specialists writing back to inform the referring doctor what they found or advised!

So now you know what to do when you need a referral letter. You don’t have to panic. It is the responsibility of every doctor to know when to refer a child and to issue appropriate referral letter to the right specialists and clinics.

Thank you for reading. Keep being informed and child-health intelligent!

#DrGbemiATP #Askthepaediatricians #Paediatriciansmemoirs