MICA · FIRST-LINE LEARNING NOTES
Understand, prioritise and organise follow-up
Useful specialist advice answers an explicit clinical question and supports continuity of care. Referral does not end responsibility for follow-up.
State the question that will change a decision
Specify whether the request concerns diagnostic confirmation, investigation choice, organ threat, treatment adaptation or coordination of multiple conditions. Summarise the problem, duration and discriminating findings in a few lines. Highlight information affecting priority. Acute deterioration must not be managed through a routine appointment letter merely because a chronic condition is already under specialist care.
[1][2]Provide the necessary information
Include current medicines, allergies, relevant comorbidities, examination, dated results and trends rather than an unannotated collection. Distinguish completed tests, outstanding results and hypotheses. Avoid duplicating a usable recent investigation; ask which additional information would actually alter the decision. In multimorbidity, document independence, frailty, transport barriers and treatment burden so recommendations are feasible.
[1]A useful referral asks a defined question about diagnosis, testing, treatment or shared care. Summarise the clinical trajectory, impact and factors increasing urgency. Include actual medicines, documented allergies and patient constraints. A large dossier without a clear question can hide the most important information.
[3][1]Choose the pathway and share decisions
Select the service according to the organ at risk, dominant syndrome or need for internal medicine synthesis. When urgency is uncertain, seek direct clinical discussion through available local channels. Explain the purpose of referral, options and uncertainties; check understanding and priorities. Weigh expected benefits of tests or treatment against burdens and risks.
[3][1]Close the referral loop
Check that assessment occurred and review the conclusions with the patient. Convert recommendations into an actionable plan: who prescribes, checks results, reviews progress and provides contact. Document disagreement or access barriers and arrange an appropriate alternative. If the condition changes before assessment, reconsider priority rather than preserving the original timetable by default.
[3][1]A learning situation
FICTIONAL CASE · SELF-REFLECTION WITHOUT A SCORE
An older person with diabetes, kidney disease and several prescriptions receives advice from two specialists. Some tests are requested twice and he does not know who should change treatment. Travel is difficult.
What should a coordinating consultation achieve?
Read the reasoning
Bring the advice together, reconcile prescriptions and agree a shared plan that avoids duplication. Assign responsibility and review arrangements for each action. The patient’s priorities and appointment burden should guide organisation; another untargeted referral alone would not resolve the coordination problem.
References and scope
- Multimorbidity: clinical assessment and management — Recommendations ↗
- Suspected sepsis in people aged 16 or over (NG253): evaluating risk ↗
- Shared decision making — Recommendations ↗
Original educational synthesis for adult first-line practice. International references must be interpreted with the clinical setting and local care pathways. Independent human scientific review remains to be confirmed.