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Regulation Matters 2018 - Issue 2

Professional Practice Question

Does the College have any requirements for how RDs should accept client referrals in their dietetic practice?

The College does not require a physician’s referral for RDs to see clients, nor does it restrict them from seeing clients who are referred by other health care providers. The guiding principle for all referrals is that regardless of how a client is referred, the reason for the referral should always be based on client need and focused on providing safe, competent and ethical dietetic services.
 
Identifying a need for dietetic services through a screening or prioritization tool is acceptable and can be a helpful way to manage both risk and workloads for dietitians. The ability for clients to self-refer to dietetic services is core to private practice and facilitates entry into publicly-funded services such as diabetes education centres, community and public health programs.

Organizational Policies

Comply with any organizational protocols surrounding receiving or making referrals as this process may be dictated by specific facility or program policies. In some cases, the ability to see a client/patient is dependent on a referral by a particular health care practitioner.
 
In the interest of effective interprofessional collaboration, liaise with your team to better understand any requirements for making referrals. Effective communication of referral policies is important so that everyone on the health care team is aware of the process to follow.

Client Referrals to Other Healthcare Providers

An important aspect of professionalism is knowing the limits of your personal dietetic scope of practice and competence. If a client needs other health care services, including specific dietetic services, that are beyond your ability or dietetic scope, then that client should be referred to another qualified RD or health professional. Referrals can be made to individual practitioners with expertise in a particular area of practice, or more generally by directing clients to community programs or websites that enable users to search for practitioners in a particular region by area of practice (e.g. the Find a Dietitian section of the Dietitians of Canada website). This is a requirement under the under the College’s Professional Misconduct Regulation, under the Dietetics Act, 1991, which defines misconduct as:
 
“19. Treating or attempting to treat a condition that the member knew or ought to have known was beyond his or her expertise or competence.”
 
In addition, when an RD leaves or closes their practice, they must the requirement outlined in the College’s Professional Misconduct Regulation which defines professional misconduct as:
 
“9. Discontinuing professional services that are needed unless,
  1. the client requests the discontinuation,
  2. alternative services are arranged, or
  3. the client is given reasonable notice to arrange alternative services.”

Referrals & Conflict of Interest

 Offering or receiving a benefit for a client referral is a conflict of interest. The conflict of interest is that the RD is or could be motivated by personal financial gain rather than client need. Always avoid referrals for profit or gain, even if the amount is small. This applies to offering or accepting a benefit or payment for referrals to or from another provider, organization or service, for example, by suggesting that a client joins a gym for which the RD receives a payment for every referral.
 
For more information, refer to the Conflict of Interest professional practice resource section of the College’s website. 

Summary

  • Always be focused on providing safe, ethical and competent client-centred care when making or receiving referrals
  • Comply with any organizational policies surrounding referrals.
  • Avoid making or receiving referrals for profit