Dialogue Volume 15, Issue 3 2019 | Page 35

POLICY MATTERS Clarifying the "Effective Referral" Requirement Taking positive action to ensure patient is connected satisfies requirement in two high profile policies A s part of its policy redesign process, Council has clarified the language of its “effective referral” requirement that is embedded within two high profile policies. Both the College’s Professional Obligations and Human Rights and the Medical Assistance in Dy- ing policies have sought to balance the rights of physicians who choose to limit the services they provide for reasons of conscience or religion with patients’ right to access care. To achieve this balance, an expectation was adopted requiring physicians who have a conscientious objection to make an “effective referral” to another non-objecting, available, and accessible physician, health-care professional, or agency. Council, however, has recognized that the term “effective referral” can be a source of confusion, as the term “referral” has a pre-existing clinical meaning that is different from what these policies require. The policies previously defined an effective referral in relation to making a ‘referral’. As the effective referral requirement has always rec- ognized that sometimes a referral in the clinical sense will not be neces- sary to ensure access to care, Council directed that the language of the policy be updated to define effective referral as “taking positive action to ensure the patient is connected” to a non-objecting, available, and acces- sible physician, health-care provider, or agency. This language was previ- ously found in the College’s Effective Referral Fact Sheet, but has now been incorporated into the policy. “The change simply incorporates the definition from the Effective Referral Fact Sheet directly into the policy in a manner that preserves the College’s expectation and retains the term “effective referral”, which has become part of the vernacular in this space, while further minimizing the potential for confusion,” said Craig Roxborough, Manager of the Col- lege's Policy Department. Key aspects of the requirement Effective referrals do not need to be made directly to another provider. A connection can be made to an agency charged with facilitating referrals for the health-care services. There is no requirement for effective referrals to be made in writing; a warm hand-off to a colleague or contacting the Ontario Care Coordination Service for MAID is sufficient. An effective referral does not require the physician to assess the patient for eligibility or suitability for the service for which they are being referred. MD ISSUE 3, 2019 DIALOGUE 35