Writing patient reports can feel like a thankless task, yet the rewards can be many and far-reaching.
One aspect of patient care that meets with a spectrum of response – from disdain, to derision, and even barely masked tolerance – is writing patient reports and referrals.
I commonly hear, “Writing reports has never increased the number of returning patients to my practice, or resulted in any increased referrals to me”.
I would be the first to agree that this task can eat up significant time and energy. However, I would argue that the returns for doing so can be great.
Referrals that are poorly written, too longwinded and full of irrelevant details are likely to be gobbled up into the black hole of no return
To adapt Oprah Winfrey’s quote, ‘Turn Your Wounds Into Wisdom,’ I suggest, ‘Turn Your Words Into Wisdom’… and explore all opportunities for patient and practice growth.
Think about how much you appreciate receiving a follow up report about a patient you’ve referred to an ophthalmologist, and the peace of mind you have once you know your patient’s outcome.
Reframed in that context, it’s easy to realise that a well written report, outlining a patient’s outcome thanks to your efforts and abilities, has the potential to generate similar appreciation from fellow colleagues. Over time, it will also help build recognition of your clinical abilities, and lead to more referrals.
Reports and Referrals will Optimise Co-Management
There are several reasons why succinct yet informative referrals and reports will optimise co-management:
Share your level of clinical expertise
The expectation for best practice includes provision of a report to the patient’s other healthcare providers about any ocular conditions or care that may have systemic ramifications, particularly, for example, their absence or presence of diabetic retinopathy. Doing so can manage complications and improve patient outcomes.
Coordinate care from multiple allied health practitioners
Patients with multiple ocular conditions can be the most challenging because they require so much TLC and a truly multi-specialist approach… but that’s where we shine best!
At a busy ophthalmology clinic, with waiting and consulting rooms full of patients, we have a little bit more luxury of time to thoroughly explain conditions to patients in a way that complements the ophthalmologist’s care, to prescribe what’s needed to resolve their issues and to report back to colleagues to ensure, particularly in complex cases, that there is optimal care. Reports are essential between practitioners for management of any butterfly effects of one management or treatment affecting other treatments from other practitioners.
Reporting back to allied health care professionals will also highlight the way in which your clinical care and skill set can complement theirs, and in doing so, optimise care of their existing and future patients.
Become an Essential Within the ‘Go To’ Referral Network
The right referral letter or report to a fellow allied health practitioner, ophthalmologist, optometrist or GP can build trust and rapport, identify you as a practitioner who is collaborative and distinguish you as very patient-focused and outcome-focused. Additionally, attending ophthalmology clinics for training and other purposes, and making professional visits to GPs to explain the specific conditions you are able to co-manage, will establish you as a colleague in their ‘Go To’ referral network.
Of course, while reports are great, they are just a reflection of the patient care provided and the biggest megaphone for co-management is the patient. I recently had a patient who texted her ophthalmologist as she left my practice for the first time. Her ophthalmologist immediately texted me, and the feedback loop had closed by the time I walked back to my consultation room. In his text to me, the ophthalmologist said he gets glowing patient reviews from everyone he refers to my care.
Her message was a compliment both to the ophthalmologist, saying how good he was for referring her to see me, and to me, about how the care she received was “brilliant”. Reports are part of building that win-win for everyone involved.
What Ophthalmologists Want
To research this article, I asked a few ophthalmology colleagues for their feedback to a number of questions:
What should a referral letter from an optometrist include?
The most important thing is a clear reason for seeking the referral.
Your referral letter should be short and concise, but have essential details like the patient’s refraction and best corrected visual acuity (BCVA)… and why you want certain things investigated.
If you’re feeling brave, a good ophthalmologist will not be offended if you write any differential diagnoses or a tentative diagnosis that you want them to investigate.
Don’t go overboard… the adage, ‘Keep It Simple Stupid’ (KISS) applies here. Referrals that are poorly written, too longwinded and full of irrelevant details are likely to be gobbled up into the black hole of no return.
Nor should you make them too brief. I once came across a referral letter that caused the ophthalmologist and me to chuckle and ‘LOL IRL’. Something ophthalmologists tell me they come across all too often is a referral post it note with the patient’s name and the BCVA for the right and left eye, eg. “John Smith, R 6/15, L 6/12”.
Being guilty of going overboard, I find the best way to balance my referrals is to have a summary line, in bold at the very top, clearly stating the reason for referral, followed by bullet points containing the information described above.
Is it useful to send a report for patients referred to you?
Although the current standard of care doesn’t require you to send a report for patients that are referred to you, the handful of ophthalmologists I spoke to said a report would be essential for co-managed patients.
Over the years, I have seen the standard of care improve considerably as a result of quality reports between practitioners that track patient treatments and outcomes. And as a result of referrals and reports sent by optometrists I believe we are increasingly recognised as primary eye care practitioners, and more readily accepted by the local GP community.
The Case of Sean
I have seen many instances of contact lenses restoring vision and rescuing eyeballs – sometimes when nothing else works. I have seen so many profound improvements to my patients’ lives with these ingenuously technical, tiny bits of plastic.
When I first met Sean* three years ago, he was in his early 20s, and accompanied by his fiancé. Sean was considered almost legally blind due to advanced bilateral keratoconus, and with such limited functional vision, was unemployed. His right eye could barely make out the eye chart; his left eye made it to just the largest letters. I used to think those massive letters were there to give something for patients to start on that would help build their confidence. I have been humbled by how little vision some patients function with, and wonder how they’ve been able to cope when they present with such little eyesight.
Sean was referred to me by his ophthalmologist and Sydney Eye Hospital as a last-ditch effort to correct his keratoconus with contact lenses. He came with a track record of many attempts wearing rigid contact lenses fitted by a few different specialty contact lens practitioners, of which none had worked, as each lens constantly displaced, and would frustratingly fall off easily. The advanced nature of his condition meant he was a challenging fit.
At that time, he said someone had passed judgement that, “he was blind, didn’t have a job, didn’t have prospects, and was worth giving up on.” I prescribed his new corneoscleral contact lenses, his vision was corrected to 6/9 and 6/12 in each eye, 6/7.5 together – nearly 6/6.
Fast forward three years, and Sean is now the leading Team Manager of a new business that’s doing well. He works six to seven days a week, and is being offered a partnership in the business in the very near future. On his last visit, he told me his contact lenses had provided the vision that made it all possible.
My report back to Sean’s ophthalmologist describing this successful outcome cemented a new referral relationship, and has benefited many patients in a similar way.
“Write Like It Matters, And It Will,” Libba?Bray
A well written?referral, or, even better, a well written?report,?explaining a successful outcome for a patient,?can be incredibly helpful to build recognition of your clinical skills and?demonstrate to fellow practitioners how you can help other patients.?More importantly, it allows fellow colleagues in complementary?professions?to?identify how we can work together to improve?patient outcomes.?
In the inspiring words of Martin Luther King, ‘If you want to change the world, pick up your pen and write’… or hit the ‘Write Letter’ button on?Sunix,?or?Optomate.?
Happy prescribing, and happy writing.?
Margaret Lam is an optometrist in theeyecarecompany practices in greater Sydney and Sydney CBD and an Adjunct Senior Lecturer at the School of Optometry and Vision Science at UNSW. She also works as the Head of Optometry Services for George and Matilda Eyecare. Margaret practises full scope optometry, but with a passionate interest in contact lenses,retail aspects of optometry and successful patient communication and management. She has extensive experience in specialty contact lens fitting in corneal ectasia, keratoconus and orthokeratology and is a past recipient of the Neville Fulthorpe Award for Clinical Excellence.
Margaret writes ‘mipatient’ on alternate months with Jessica Chi.