Medical Council of Canada MCCQE Part 1 MCCQE Question # 36 Topic 4 Discussion

Referrals should be medically indicated. Physicians are not obligated to refer simply because a patient (or colleague) requests it, especially when it may lead to unnecessary care. The ethical and appropriate action is to explain your medical reasoning and decline an unwarranted referral.

Toronto Notes 2023 – ELOM, “Professionalism and Resource Stewardship” Section:

“Physicians have a responsibility to act as gatekeepers to specialist services and should not refer patients when criteria are not met. Explaining the reasoning and declining the request respectfully is appropriate.”

MCCQE1 Objectives (ELOM > 99-1: Professionalism and Clinical Judgment):

“Candidates must demonstrate ethical reasoning in managing requests for unwarranted interventions.”

Involving the emergency department (B) or another physician (C) is not appropriate unless there's a true conflict of interest. Calling a consultant (E) may be unnecessary if no medical reason exists.

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