American Journal of Public Health Research, 2015, Vol. 3, No. 1, 31-35 Available online at http://pubs.sciepub.com/ajphr/3/1/5 © Science and Education Publishing DOI:10.12691/ajphr-3-1-5 The Practice of Medical Referral: Ethical Concerns Anyanwu E. B. 1,* , Abedi Harrison O. 2 , Onohwakpor Efe A. 2 1 Department of Family Medicine, Delta State University Teaching Hospital, Oghara, Oghara, Nigeria 2 Department of Obstetrics and Gynaecology, Delta State University Teaching Hospital, Oghara, Oghara, Nigeria *Corresponding author: ebirian@yahoo.com Received November 17, 2014; Revised January 19, 2015; Accepted February 01, 2015 Abstract Medical referral is the act of sending a patient by one professional care giver to another, who may be a specialist and therefore be more knowledgeable in the diagnosing and further management of the patient. Most cases of referral of patients is therefore for proper diagnosis, adequate investigations and their proper treatment by the receiving specialists. It is mostly assumed and believed that patients depend on the medical information available to their health care providers. Therefore, the need for a referral, its appropriatness, timing and to whom the referral is made to mostly depends on the attending physician. This should be done after due consultation with the patients family and appropriate consent obtained. It is believed that a health practitioner should make a referral when he thinks that it will be of benefit to the patient and not when he wants to avoid the challenges of unraveling the patients’ complex problems. Also, referral should not be made to avoid possible death of the patient in a hospital so as not to worsen its statistics. Unfortunately, the seemingly good intention of referring of patients may cause a conflict of interests when physicians because of inherent financial gains refer patients to facilities that they own or have investment interest in. Such referral challenges as self-referral, and fee-splitting whereby a fee is paid to one physician by another for a referral is unethical, and are known to occur. Several “Anti-referral Laws” have subsequently been set up to prevent such actions and protect patients against abuse by health workers. Keywords: patients, physicians, treatment, ethics, diagnosis Cite This Article: Anyanwu E. B., Abedi Harrison O., and Onohwakpor Efe A., “The Practice of Medical Referral: Ethical Concerns.” American Journal of Public Health Research, vol. 3, no. 1 (2015): 31-35. doi: 10.12691/ajphr-3-1-5. 1. Medical Referral In the act of medical practice, referral is the transfer of a patient’s care from one physician or clinician to another. It involves one physician recognizing that a patient under his care needs some expertise or skills that can be found in another physician. This other physician maybe working in the same institution with the referring physician or in a different institution entirely. Tertiary care is usually done by a referral from either a primary or secondary care centre to a specialist who serves in such tertiary centres [1]. Appropriate referral is an integral part of a complete quality health care management, and should be based on the unique needs of a patient. It is assumed that the referring physician has the required skills and knowledge in diagnosis and treatment to determine when a referral is needed. 2. Ethical Observation Consider a situation where a family physician in a busy clinic had seen a patient, and had taken a proper history, examined him and then made a working diagnosis that required the patient to be admitted onto the ward for investigations and further management. The physician at this point explained his findings and thought to his patient and relations around and further explained the need for the patient to be admitted onto the ward so as to closely monitor his expected recovery and improvement. The patient himself, and all his attendants and relations present understood the detailed explanation and all agreed for the admission to be made so that appropriate treatment can be administered. Then, the problem of no vacant bed space arose. There just was no free bed available in the hospital. All efforts made to get a place for him, even on the orthopedic and surgical wards were not successful. At this point, the need for a referral was suggested to them. A senior member of the extended family was informed by one of the attendants present by telephone, and he came over to the hospital, very furious and quite surprised that such a problem could possibly endanger the life of the patient. He announced very loudly that it was “criminal” for us to even contemplate a referral of the patient out of our facility. He maintained that since we have made a diagnosis that the onus was now on us to ensure that we get a bed space for the patient and treat him. It did not matter what we had to do, even if we had to put a mattress on the floor. Nothing else was to be accepted by him. Furthermore, he stated that he was sure that the other place where we may send the man to “will not be able to see what we have seen” and therefore cannot administer