The referral cruise

Margaret, in her late 30s, had struggled to conceive which made her life busy with fertility concerns—so much that she sometimes neglected other aspects of her health. She eventually became pregnant but her first child had chromosomal problems. Her second child however was healthy.After settling into motherhood, Margaret (not her real name) confided in me about something on her back that had been present for over two years. Describing it as a swelling. She did not recall any trauma or injection in that area.Upon examination, I discovered three separate lumps closely situated: soft, smooth and very dark in colour, yet not tender, precisely along the lumbar spine. I ordered an ultrasound, which only added to the mystery. The report offered inconclusive findings with multiple potential diagnoses, including abscess, tumour or cyst, but suggesting a surgical opinion.Read: Dr. Jabir Jassam: ‘If you terminate me, I will ruin your life’Margaret was referred to a surgeon with the ultrasound report but, after some time, the surgeon declined the referral, suggesting a plastic surgeon instead.Margaret was sent to a plastic surgeon with the surgical report as well as the ultrasound findings. After several weeks, the plastic surgeon too, declined the referral and suggested that a surgical evaluation would be more appropriate.Filled with hope, I directed Margaret to a different surgeon, armed with letters from both the reports of the ultrasound and the plastic surgeon. However, after a few weeks, the surgeon returned the referral to me, expressing discomfort with touching the lesion due to its proximity to the spinal column. Concerned about the risk of spinal cord involvement, the surgeon recommended consultation with a neurosurgeon.Taking swift action, I referred Margaret to a neurosurgeon, ensuring to include letters from the two general surgeons and plastic surgeon. I made certain to include the most recent communication from the surgeon to pre-empt any further referral requests.As of now, I am eagerly awaiting the neurosurgeon’s response, though I anticipate another decline.My plan is, if the neurosurgeon declines the referral, I will request an MRI. I am hopeful that there will be no worrisome features and then, at least, I will have peace of mind.I completely understand my colleagues’ reaction—they are overwhelmed—but the purpose of writing about this is to address the time we spend on just one simple referral. And, of course, this is not just happening only once in a lifetime but it actually happens every now and then.I forgot to mention, Margaret remains unaware of the three declined referrals, but she expressed her displeasure with the “delay in her care.”Dr. Jabir Jassam is a family physician in Ottawa.

The referral cruise

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