The NSW Civil & Administrative Tribunal has recently made comment on the duty of a general practitioner referring to and working with a specialist1.

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The observation provides helpful guidance on the requisite standard expected of a practitioner when referring to a specialist.

The complaints against the doctor alleged unsatisfactory professional conduct and professional misconduct in relation to the prescription of Schedule 8 and Schedule 4D drugs and the failure to maintain adequate records for multiple patients2. The doctor admitted many particulars of the complaints.

During the course of giving evidence however, the doctor said that one of the patients was under the care of a specialist and that the treatment regime (namely the prescription of Diazepam, Methadone and Temazepam) was supported by that specialist3. This evidence was not accepted by the Tribunal. In another instance, the Tribunal found that the doctor failed to follow the advice of a specialist on two occasions4.

The doctor’s registration was cancelled for a minimum of two years5.

In the decision the Tribunal states: 

Referral to a specialist goes beyond the administrative task of writing a letter. The appropriate and expected standard involves obtaining the opinion sought, considering the advice and taking appropriate and considered action. In cases of chronic conditions where patients are on medication, constant periodic reassessment of the condition is required. This is to ensure accuracy of diagnoses, status of the condition, including signs and symptoms, and the impact of treatment. Because the personal circumstances of patients may change it is desirable to verify provisional diagnoses, and physical examinations should be undertaken to determine future management strategies6.

Although this case centred on a general practitioner, the decision outlines what is expected when a referral to a specialist is made during the course of treatment. It is likely the same standard will apply when referring from specialist to specialist.

Although this may appear to be common sense, at MIGA we frequently see notifications of alleged ‘failure to follow up’ or ‘lost to follow up’. This is not limited to general practitioners and includes the failure to review specialist reports, laboratory and radiological results. Frequently, incorrect assumptions are made about who is managing the patient.

Risk management tips

The case is a reminder for all of our members to:

  • Approach your patient’s care in a collegial way. Engage with your patient’s specialist and review their recommendations regularly
  • Seek peer support, whether that be with a practitioner within your own group or a specialist. Ensure any discussions are documented
  • A second opinion may be appropriate if you have reached an impasse with your patient. This is particularly important for patients who may be having difficulties with addiction
  • Take the time to review previous entries/attendances to ensure results have been followed up. Document this review has taken place
  • Don’t assume that a colleague is following up or managing for you. Confirm with the patient and other treating doctors who is responsible for various aspects of the patient’s care
  • Document telephone discussions in the patient record
  • Ensure your practice has a thorough follow-up and recall system.

For examples of case studies on this subject please see our risk management resource library. If you need advice on this or any other matter please call our Claims and Legal Services team on 1800 839 280.

1 Health Care Complaints Commission v Lo [2016] NSWCATOD 119. A copy of the decision can be found here: https://www.caselaw.nsw.gov.au/decision/57ce1e5ee4b058596cb9f327
2 Above N1 at 8 and 9
3 Above N1 at 107
4 Above N1 at 37
5 Above N1 – Orders (1). As per Order (2) the practitioner may not apply for a review of Order (1) for a period of 2 years from the date of the decision
6 Above N1 at 163

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