When a patient is being examined in one of the clinics and the optometric student and doctor feel the patient needs further consultation or is of special interest for teaching purposes, an intra-clinic referral is made. For example, a patient seen in Primary Clinic with an active retinal lesion may be referred for an ocular disease work-up by the Medical Module staff for consultation with the patient. Or, a patient who has an old, inactive lesion might be referred for an ocular disease work-up because of teaching interest.
An intra-clinic referral, once approved by the instructor, is implemented by scheduling the patient to the desired Clinic (preferably referring the patient to the same student clinician for continuing care). After the diagnosis is made in the specialty clinic, a letter or pre-printed form completed and signed by both the specialty clinic instructor and student clinician should be incorporated into the patient file for the referring doctor and student clinician.
There are two types of outside referrals that an optometry clinic and private practitioner are involved with:
- The referral from another doctor (outside UCBSO to the Clinic) for additional expertise and consultation.
- A Clinic patient being referred outside to another health care practitioner.
Referrals from outside doctors are usually made to one of our specialty clinics for consultations in low vision, squint diagnosis, VER, vision functions, etc. A referral letter from the outside practitioner should, and usually does, accompany the patient. This patient is treated like an intra-clinic referral patient except that some basic information may need to be taken first. A consultation report written by the optometric intern and signed by both the intern and the doctor in charge is sent to the referring practitioner. A copy of this report remains in the patient’s record at U.C.B.S.O. Outside referrals should be restricted to the specific request. For example, a patient referred from an OD or a MD for Infant Clinic evaluation should receive just that. Producing eyewear materials for an outside patient usually results in “the loss of further referrals from that source.”
A referral from the Clinic to an outside practitioner is very common at the school and in private practice. Two types of outside referrals can occur: 1) emergency and 2) non-emergency. In an emergency referral (a situation which cannot be cared for in our Clinic), a call or consult to the practitioner at the referred agency should always be the first step (such situations include retinal detachment, acute angle closure glaucoma, iritis, etc.). If the patient is a U.C. student, the referral will be made to the Tang Center. If the patient is not a U.C. student, then an appropriate outside practitioner will have to be contacted. For medical matters, refer preferentially to a patient’s personal physician or refer to the network of certain local physicians who have worked well with the Clinic in the past. Explain the U.C.B.S.O. clinical findings and suspected diagnosis to the consulting doctor, and establish the time and location of the appointment. Write down the doctor’s name, time and place of the appointment on the clinic record form and for the patient (e.g., “Dr. Smith, Herrick Hospital Emergency Room, Immediately, or Dr. Smith, 22 Telegraph Avenue, Suite 2R, 1:15 p.m., Thursday, April 22”). The referral does not end with the phone call. In most cases a referral letter should be written and sent to the consulting doctor outlining the findings, reason for the referral, and requesting a report. This is beneficial for legal reasons and offers better patient control and care.
In a non-emergency referral, the appointment is usually made by phone. The consulting doctor or their office is advised that a referral letter will arrive before the patient’s scheduled appointment. The patient is advised of the appointment time, place and doctor (preferably in writing). All contact with the outside doctor and patient is documented on the Clinic record, including all phone conversations. The optometric student and the Clinic doctor must sign the referral letter.