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In this issue of JABFP, Williams and Peet report and comment on their findings of a timely study in Ohio of the perceptions and values placed on various kinds of clinical information by referring physicians and consulting specialists during the process of consultation and referral. l Their paper follows up on a long interest by Williams and his colleagues on the consultation process. A previous paper in 19772 described six inherent problems during the consultation process, in large part resulting from one or another type of failure in communication between referring physicians and consultants. The consultation process, for all its importance, has received inadequate study over the years, and its complexities and outcomes are still not well understood. In an early study on the topic, Williams and his colleagues3 defined the five key steps in the course of a consultation involving a referring physician and a consulting physician. .. 1. The referring physician defines the need and purpose of the consultation and referral as mutually understood with the patient. 2. The referring physician communicates these needs to the consulting physician. 3. The consulting physician addresses the problems as requested. 4. The consulting physician communicates findings and recommendations to the referring physician. 5. The referring physician, consulting physician, and the patient come to a clear understanding of responsibilities for continuing care.

Communication problems and needs in the consultation and referral process.