REFREC006
GENERAL MEDICINE REFERRAL RECOMMENDATIONS
1. General Medicine is a broad based specialty covering a wide area of non-surgical prevention, diagnosis and treatment of adult and adolescents with diseases
involving any of the organ systems, especially the management of conditions or complications involving more than a single organ system. The General
Consultant Physician provides consultative support to General Practitioners and other Specialists including Obstetricians and Gynaecologists, Psychiatrists,
Sub-specialists in medicine and surgical specialties. The General Consultant Physician cares for seriously ill patients in hospital, particularly non-selective acute
admissions. General Consultant Physicians may have one or more sub-specialty interests. Hence, General Medical referrals can be divided into three broad
categories:
a.
Undefined conditions (particularly generalised disease or non-specific problems)
b.
Multi-system disease or where multiple diagnoses exist in one patient.
c.
Sub-specialty problems with or without additional medical problems.
Diagnosis / Symptomatology
Evaluation
Management Options
Referral Guidelines
Sub-specialty problems with or without
diagnoses: Many of the conditions
listed below are identified in subspecialty referral protocols but are
often dealt with by General Physicians.
The following conditions are examples
and are not an exhaustive list.
These general symptoms may include
any and/or all of the general or specific
problems noted. Thorough history and
physical examination is required for
determining the diagnosis. All cases
should include alcohol and tobacco
use, drug and allergic history and
family and occupation history.
Specific treatments depend on the
specific problem identified, as below.
Circumstances
for
referral
are
indicated below with reference to the
appropriate specialty/specialties.
Evaluation/investigation results should
always be provided with a referral
where possible.
Appropriate baseline investigations
that may be considered by the referrer
prior to referral.
Last updated February 2006
Page 1 of 6
REFREC006
Diagnosis / Symptomatology
Cardiology






Palpitations
Syncope
Hyperlipidaemia
Hypertension
Murmurs
Chest pain
Dermatology


Rash
Adverse drug reaction
Endocrinology/Metabolic Disease



Diabetes
Thyroid disease
Abnormal physiological and
biological data
Gastroenterology/Hepatobilliary/
Pancreatic







Evaluation
Management Options
Referral Guidelines
As per Cardiology Referral
Recommendations.
As per Dermatology Referral
Recommendations.
As per Endocrinology/Diabetes
Referral Recommendations.
As per Gastroenterology Referral
Recommendations.
Dyspepsia
Nausea and vomiting
Haematemesis
Abdominal pain
Diarrhoea
Altered bowel habit
Chronic liver disease
Last updated February 2006
Page 2 of 6
REFREC006
Haematology/Immunology


Undefined anaemia
Thrombotic disorders
Medicine for the elderly




Instability/falls
Immobility
Incontinence
Cognitive Impairment
Neurology





Seizure
Stroke
Headache
Tremor
Movement disorders
Oncology


Suspected Malignancy
Palliative Care
Renal Medicine



Acute  chronic renal failure
Haematuria
Proteinuria
Respiratory Medicine



Pulmonary infection
Neoplasia
Airways disease
Last updated February 2006
As per Haematology/Immunology
Referral Recommendations.
As per General Medicine for the
Elderly Referral Recommendations.
As per Neurology Referral
Recommendations.
As per Oncology Referral
Recommendations.
As per Renal Medicine Referral
Recommendations.
As per Respiratory Medicine Referral
Recommendations.
Page 3 of 6
REFREC006
Rheumatology



Inflammatory joint disease
Soft tissue rheumatism
Systemic connective tissue
disease
As per Rheumatology Referral
Recommendations.
Sexual Health



Asymptomatic screening
Common symptomatology
Sexual health advice.
Last updated February 2006
Page 4 of 6
REFREC006
Diagnosis / Symptomatology
Evaluation
Unwell with a sustained raised ESR
usually > 40mm.
Normal values:
Female: Age + 10
2
Male: Age
2
Standard history and examination
including ophthalmoscopy.
Investigations:
FBC, MSU, Urine protein.
Consider the following:
Electrolytes and creatinine, calcium,
protein electrophoresis, LFTs, CRP
and CXR.
New onset of fatigue lasting more than
3 months.
Standard history and examination
including symptoms of sleep apnoea.
Investigations:
FBC and ESR, MSU.
Consider the following:
Electrolytes and creatinine, calcium,
LFTs, CRP, TFT, plasma glucose,
CXR.
Pyrexia of unknown origan (PUO)
Standard history and examination with
particular reference to overseas travel
and possible infectious disease
contact.
Management Options
Note:
In case of suspected polymyalgia
rheumatica, a trial of 10 mg
Prednisolone (daily) for two to three
days. If doubt remains urgent
outpatient referral to physician. Crossrefer Rheumatology Referral
Recommendations.
Referral Guidelines
Routine Referral Category 3 for
diagnosis difficulty and possible
management.
Routine Referral Category 3 for
difficulty in diagnosis and possible
management.
Symptomatic Treatment pending an
accurate diagnosis.
Refer urgently if there is thought to be
significant underlying condition
otherwise refer PUOs after two weeks
for assessment.
Investigation:
FBC, film and ESR, MSU.
Consider the following:
Electrolytes, creatinine, LFTs, Paul
Bunnell, specific serology tests, blood
cultures, CXR.
Last updated February 2006
Page 5 of 6
REFREC006
Diagnosis / Symptomatology
Multiple System
Disease/Diagnoses
- Multiple Separate Entities –
- One Patient, eg. Syndrome X
-
Multiple System Disease
Entities eg. SLE
Haemochromatosis, HIV,
sarcoidosis
Last updated February 2006
Evaluation
Standard history and examination.
Particular emphasis on family history
and risk factors (alcohol, tobacco).
Day time sleepiness. Cross-refer to
specific diagnosis Referral
Recommendations.
Management Options
Referral Guidelines
Note:
“Multiple system disease/diagnosis”
assessment and management should
be referred to a generalist rather than a
sub-specialty physician in the first
instance.
Standard history and examination.
Cross-refer to specific diagnosis
Referral Recommendations.
Page 6 of 6