Physician to Physician: Guidelines on Referral and Delegation in clinical practice

Referral and Delegation are an inherent part of any medical practice. Treatment of any illness, today, requires a multi-disciplinary approach, with doctors across specialties working together to improve the condition of the patient.

MCI in the INDIAN MEDICAL COUNCIL (Professional Conduct, Etiquette and Ethics) Regulations, 2002 section 4 deals with the responsibilities of physicians towards each other. Its important that all physicians should be aware of these:-

4.1 Dependence of Physicians on each other : A physician should consider it as a pleasure and privilege to render gratuitous service to all physicians and their immediate family dependants.

4.2 Conduct in consultation : In consultations, no insincerity, rivalry or envy should be indulged in. All due respect should be observed towards the physician in-charge of the case and no statement or remark be made, which would impair the confidence reposed in him. For this purpose no discussion should be carried on in the presence of the patient or his representatives.

4.3 Consultant not to take charge of the case: When a physician has been called for consultation, the Consultant should normally not take charge of the case, especially on the solicitation of the patient or friends. The Consultant shall not criticize the referring physician. He / she shall discuss the diagnosis treatment plan with the referring physician.

4.4 Appointment of Substitute: Whenever a physician requests another physician to attend his patients during his temporary absence from his practice, professional courtesy requires the acceptance of such appointment only when he has the capacity to discharge the additional responsibility along with his / her other duties. The physician acting under such an appointment should give the utmost consideration to the interests and reputation of the absent physician and all such patients should be restored to the care of the latter upon his/her return.

4.5 Visiting another Physician’s Case: When it becomes the duty of a physician occupying an official position to see and report upon an illness or injury, he should communicate to the physician in attendance so as to give him an option of being present. The medical officer / physician occupying an official position should avoid remarks upon the diagnosis or the treatment that has been adopted.

Apart from the MCI code, which acts specifically in the Indian Context, one should also be aware about the guidelines laid down by the General Medical Council, UK. Following are the salient features of the said guidelines with respect to Delegation as well as Referral

Delegation involves asking a colleague to provide care or treatment on your behalf. When delegating care you must be satisfied that the person to whom you delegate has the knowledge, skills and experience to provide the relevant care or treatment; or that the person will be adequately supervised.When you delegate care you are still responsible for the overall management of the patient.

Referral is when you arrange for another practitioner to provide a service that falls outside your professional competence.Usually you will refer to another doctor or healthcare professional registered with a statutory regulatory body.

The following guidelines should be kept in mind whether you are delegating or referring.

•  You should explain to the patient that you plan to transfer part or all of their care, and explain why.


•  You must pass on to the healthcare professional involved: n relevant information about the patient’s condition and history and the purpose of transferring care and/or the investigation, care or treatment the patient needs


•  You must make sure the patient is informed about who is responsible for their overall care and if the transfer is temporary or permanent. You should make sure the patient knows whom to contact if they have questions or concerns about their care.


•  You should check that the patient understands what information you will pass on and why. If the patient objects to a disclosure of information about them that you consider essential to the safe provision of care, you should explain that you cannot refer them or arrange for their treatment without also disclosing that information.

You read the full guidelines by clicking on the following link

• http://www.mciindia.org/Rules-and-Regulation/Ethics Regulations-2002.pdf


• www.gmc-uk.org/guidance.