CONSULTATION OR REFERRAL

To the Editor:—  Recent articles on the ethics and economics of the practice of medicine have pointed up the need for the clarification of the terms referral and consultation. Many doctors of medicine fail to make a distinction between the two, so it is not surprising to find writers in newspapers and popular magazines doing the same.Referral is generally understood as a transfer of the full responsibility of the patient to another physician who expresses willingness to accept the patient and the responsibility. The referring physician is then completely relieved of active management of the patient. There can be variations, such as referral for treatment of a certain condition while another illness is being cared for by the referring physician, but that is not usual. It is customary for the physician who accepts the patient to find out whether he is expected to send the patient back when his