Effective communication in the workplace is a nuanced skill. One of the unique communication skills that we medical professionals face, is when we make a referral to another specialty or ask for their advice. Sounds positively harmless right? I mean when it comes to referring patients, all we are doing is advocating for their needs. Unfortunately, it is not always straightforward. Even though your cause might be justified, the other person might not see it that way! This sometimes gives rise to unnecessary aggression or conflict.

In this blog post, I will be offering insights and practical tips for navigating such situations in a professional setting. The context of this blog was a discussion with my House officer attempting to refer a patient to another specialty. Even though the referral was justified, the team was reluctant to take over care. So, I discussed with my colleague the challenges we face in referring patients to other teams.

When faced with resistance, the three typical responses are to back down, respond aggressively, or stand your ground assertively. Choosing assertiveness is often the most effective approach, as it allows you to express your concerns without escalating the situation. However, balancing between assertive and aggressive is the tricky bit.

So, we discussed a stepwise approach to deal with these situations.

1.     Know the Facts: Know everything about the patient, their history, and the reasons behind your referral. Never refer to another specialty without knowing about the patient. Always go through the notes and investigations. This will make you come across as professional and reliable.

2.     Have a Structure: It is always better to present your information in a structured way. SBAR ( situation, background, assessment, and recommendation) is a useful tool. But whatever it is, make sure it is succinct. Remember, you are not a medical student, and the other person is also probably short on time. So, get to the point quickly. Also, try to have the notes in front of you, so if needed you can find the information quickly.

3.     Ask Why: If your request for referral or consultation is refused, inquire about the reasons behind it. Try to keep your tone polite and neutral and frame it in a way that your motive comes across as educational benefit. This is especially useful when discussing cases with someone more senior than you.  This opens a channel for communication and understanding.

4.     Refute Illogical Reasoning: If the reasoning presented is not logical, calmly refute it by presenting facts and building your case. Most reasonable colleagues will acknowledge a well-supported referral. This is where Google comes in handy, as it can quickly fill up your knowledge gap.

5.     Stand Up for Your Conviction: In instances where pushback persists, assertively request a review. You have presented your case and did all the relevant investigation to exclude other differentials. Clearly express your reasons behind your referral.

6.     Document Your Process: Always document the rationale behind your decisions and conversations, with whom, what, and where. Remember, in medicine, if you didn’t write it down, it did not happen!

7.     Maintain Composure: Sometimes you might face aggressive or condescending colleagues on the other side. It is challenging, but crucial, to keep your cool in the face of rudeness or aggression. Responding with composure maintains your professionalism and control over the situation.

8.     Learn from Others: Observe successful communicators in your workplace. Learn from their strategies and apply them to your communication style.

Effectively navigating referral challenges requires a delicate balance between assertiveness and professionalism. By arming yourself with information, asking questions, and maintaining composure. You might not agree with your colleague, but it should be done professionally and respectfully.  You can confidently advocate for your patients and maintain a collaborative and respectful work environment.