Consultations, Referrals, and Transfers of Care

Historically, the terms “consultation,” “referral,” and “transfer of care” have sometimes been used interchangeably. That continues to be case, with understanding of the terms varying among individuals and regions of the country. However, the AAFP believes there are essential differences among these terms.

A consultation is a request from one physician to another for an advisory opinion. The consultant performs the requested service and makes written recommendations regarding diagnosis and treatment to the requesting physician. The requesting physician utilizes the consultant’s opinion combined with his own professional judgment and other considerations (e.g. patient preferences, other consultations, family concerns, and comorbidities) to provide treatment for the patient.

A referral is a request from one physician to another to assume responsibility for management of one or more of a patient’s specified problems. This may be for a specified period of time, until the problem(s)’ resolution, or on an ongoing basis. This represents a temporary or partial transfer of care to another physician for a particular condition. It is the responsibility of the physician accepting the referral to maintain appropriate and timely communication with the referring physician and to seek approval from the referring physician for treating or referring the patient for any other condition that is not part of the original referral.

A transfer of care occurs when one physician turns over responsibility for the comprehensive care of a patient to another physician. The transfer may be initiated by either the patient or by the patient’s physician, and it may be either permanent or for a limited period of time until the patient’s condition improves or resolves. When initiated by the patient’s physician, the transferring physician should explicitly inform the patient of the transfer, and assist the patient with timely transfer of care consistent with local practice. (2007 COD) (2012 COD)