Internal medicine referrals and diagnostics performed in-house

This is my specialist field and although medical cases are investigated and treated on a daily basis in general practice, and in many cases to a high standard, a case review by a second pair of eyes can be extremely helpful.

This may culminate in a consultation with the owners where reassurance is given that everything appropriate has been done in treating their pet, or indeed, it may be the beginning of a continued work up under my supervision. I would envisage that some of the initial consultation and case review may best be done via telephone or email, but if procedures are required then these could well be carried out in the client’s own practice. The case would remain under the care of the local practitioners, but plans will be put in place for ongoing case management.

Ultrasound has become a major part of any internist’s arsenal and I have been fortunate to work with some of the best veterinary imagers over the years. I will be bringing my own ultrasound equipment to work up cases, including the collection of samples such as aspirates and biopsies.

I very much believe that in this day and age referral services should be provided on the basis of the closest possible liaison between the client’s practice and consultant. An approachable, compassionate and helpful specialist should, in effect, become part of the practice team and enhance the image of the referring general practice.

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In-House Referral - how does it work?

To those of you who feel that more options are needed in the world of veterinary referral work please read on...

In general practice there will always be those situations that need the full referral package, but for many more all that might be required is some extra expertise and specialist equipment. This would allow a greater insight into the diagnosis and management of a particular case and ensure that the first-opinion veterinary surgeon retains a much greater degree of governance over those cases.

An appointment will be made so I arrive at a pre-arranged time. The case will dictate if a consultation is needed with the pet owner. In many cases this will be preferable so that client expectations in complicated medicine cases can be managed from an early stage.

On occasions I am prepared to carry out specialised procedures in isolation following a review of the case to ensure that the procedure is appropriate. My aim is to be fairly self-sufficient, but where possible I will be using your equipment and consumables and specific expensive items e.g. PEG tubes will need to be ordered to requirement.

A report will be generated within 24 hours of the visit. The level of my involvement after the visit is likely to vary from case to case. I would anticipate putting a plan into place for ongoing management by the host practice. Some cases may require follow up visits by myself and there will still be those very ill patients that would be better being referred on to a 24 hour care facility if this cannot be provided locally. Some thought needs to be put into deciding if a case suits this in-house referral approach. You should not delay referring very sick cases to traditional referral centres if this is what the animal needs.

What I need from the referring practice?

A full history, blood test results and previous imaging results should be available and should ideally already have come to me before the visit as it might be worthwhile arranging more tests before my visit to avoid delays in work-ups and repeat visits

A veterinary surgeon or nurse needs to be available to facilitate this

A room/ reasonable space needs to be available where I can work and

For ultrasound a sturdy table for the machine, a power supply and a means of darkening the room is necessary - endoscopy is also easier in a darkened room

Pet owners should be made aware that animals may require sedation and clipping for procedures.