BMJ  2005;331:1072-1074 (5 November), doi:10.1136/bmj.331.7524.1072

Clinical review

ABC of health informatics

Referral or follow-up?

Frank Sullivan, NHS Tayside professor of research and development in general practice and primary care, Jeremy C Wyatt, professor of health informatics

University of Dundee.

The first 150 words of the full text of this article appear below.

Introduction

When patients ask their doctors if a preventable problem could have been avoided by earlier investigation or referral, the doctors can be in an unenviable position. Given the information available at the time, the response will often be a qualified, "yes." It must be a qualified response because the aspects of the problem considered during earlier encounters with patients are often unknown. The matter is further complicated by issues of trust, professional ethics, and the law.


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  		PRODIGY (Prescribing RatiOnally with Decision Support) guideline on investigation of urinary tract infection in children

 

This article discusses information flows that may have reduced the risk of Ms Smith (see box opposite) developing symptomatic renal impairment. The risk could have been reduced at three different points.

  • If her underlying vesicoureteric reflux had been diagnosed and fully investigated in childhood
  • When her chronic pyelonephritis was discovered
  • During the intervening period when no follow-up was . . . [Full text of this article]

Early detection of underlying problems

Ensuring appropriate investigation

Arranging referral

Arranging follow-up

Hospital follow-up
GP follow-up
Shared care

Patient empowerment

Clinical governance

Summary


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Rapid Responses:

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Why not?
Jeevan P Marasinghe
bmj.com, 10 Nov 2005 [Full text]
Collusion of anonymity
Wilfrid Treasure
bmj.com, 18 Nov 2005 [Full text]
Individual Responsibility vs. Collusion of anonymity
L S Lewis
bmj.com, 22 Nov 2005 [Full text]

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