A referral by phone is a spoken request from one health professional to another, or to a service, to take charge of a patient, give an opinion or organize a consultation. In France, it works best when the call is prepared, follows a fixed structure (the HAS Saed tool), shares only the information useful to the recipient, and is recorded afterwards in the patient file. The practice’s own telephone reception also plays a role, because the quality of the first contact conditions everything that follows.
This guide covers the situations in which a call is appropriate, the structure of the exchange, the clinical and administrative information to transmit, the follow-up of urgent cases, and the rules on confidentiality and traceability that apply to French practices.
Key Takeaways
- A telephone referral is most useful for verbal requests for an opinion, urgent communications, patient transfers and multidisciplinary discussions, according to the HAS.
- The HAS Saed method (Situation, Antécédents, Évaluation, Demande) gives the call a predictable order and reduces omissions.
- Medical information should travel through secure channels; informal messaging tools are suitable for administrative information only.
- Every telephone exchange should be recorded in the file like a consultation, ideally with a timestamp.
- A well-organized reception, with trained operators and clear triage rules, protects the physician’s time for calls that genuinely require a clinician.
Table of Contents
- When a telephone referral is the right tool
- How to prepare the call
- Structuring the exchange with Saed
- What information to share
- Coordinating urgent cases and follow-up
- Documentation and confidentiality
- The role of the practice’s reception
- A worked example
- Perspective
- How ClicFone supports practices handling referrals
- FAQ
- Sources
When a telephone referral is the right tool
The telephone is not the default channel for every referral. In the coordinated care pathway, the attending physician coordinates the patient’s follow-up, serves as first point of contact and orients the patient to a specialist when needed. In most routine cases, this orientation is done through a referral letter and an appointment made by the patient or the practice. The call complements the letter; it rarely replaces it.
The HAS identifies the situations in which oral communication between professionals is particularly valuable. Its guide to the Saed tool lists verbal requests for an opinion, urgent communications such as clinical deterioration or a complication, patient transfers within or between facilities, and multidisciplinary meetings. These are cases where a delay of a few days would change the decision, or where a written document would leave the recipient with unanswered questions.
A practical way to decide is to ask three questions:
- Does the answer change what happens to the patient in the next hours or days?
- Does the recipient need to ask questions that the letter cannot anticipate?
- Is the patient’s condition changing, or is the history complex enough to be misread on paper?
A yes to any of them justifies a call, followed by a written confirmation.
Urgent situations
For genuine emergencies, the Académie nationale de médecine, in a text by Bernard Hoerni, points out that the telephone is used for situations that justify the physician’s displacement or the dispatch of an ambulance, and that this is where the physician must communicate personally. A reception team can collect the first elements and put the call through, but the clinical decision belongs to the physician.
The HAS summary sheet on medical regulation describes the possible outcomes of such a call: medical advice without deployment of means, telephone prescription, orientation to an unscheduled consultation, ambulance transport, fire brigade or first responders, or intervention of a medical effector. A practice that knows these outcomes can organize its internal protocol around them.
Situations that do not need the attending physician
Some referrals do not follow the usual path. Under the coordinated care pathway, patients are normally reimbursed even without going through the attending physician in particular cases: under 16 years old, absent attending physician, emergency, patient far from home, or an attending physician who retired or changed department less than a year earlier. A specialist’s secretary who receives a call in one of these situations can note the reason, which avoids a misunderstanding on reimbursement.
How to prepare the call
A good referral call starts before dialing. The HAS recommends preparing the essential information in advance with the Saed memo, checking the identity of the person reached, and speaking clearly and slowly enough for the recipient to take notes.
Before the call, the caller gathers:
- the patient’s identity, date of birth and location;
- the reason for the request, formulated in one or two sentences;
- the current treatments, known allergies and relevant history;
- the latest examination results that bear on the question;
- the exact request: an opinion, an appointment, a transfer, a procedure.
Patients themselves can be asked to prepare. Referrals to imaging services, for example, usually come with instructions on what to confirm and bring. The same logic applies to bone density imaging, where a DEXA scan preparation checklist shows the type of information (medications, history, findings) that makes an appointment run smoothly. On the ClicFone side, the equivalent for French radiology appointments is covered in a page on what patients must confirm on the call.
Structuring the exchange with Saed
The HAS introduced the Saed tool in a guide validated by its Collège on 8 October 2014. It is the French adaptation of SBAR and structures oral communication between health professionals, including telephone referrals, urgent communications and transfers.
| Letter | Meaning | What the caller says |
|---|---|---|
| S | Situation | Who is calling, from which service; the patient’s identity and location; the concise reason for the call; the present situation described with objective facts |
| A | Antécédents | Relevant history, current treatments, allergies, previous procedures, usual state of the patient |
| É | Évaluation | The caller’s assessment: vital signs, clinical signs, what has been done, how long the situation has been evolving |
| D | Demande | What is asked of the recipient, and within what timeframe |
The order matters. Opening with the request before the context often forces the recipient to interrupt; closing without a request leaves the call without an outcome. The final step is to have the recipient restate the decision, so that both sides leave with the same understanding.
The opening of the call
The HAS guide asks the caller to state their identity and service, then the patient’s identity and location, then the reason for the call. The ARS Île-de-France emergency guide, which references the HAS document, offers a template in which the caller gives name, function and service, the patient’s name, age, date of birth and location, and the reason for the call. When the situation is acute, it adds vital signs such as heart and respiratory rates, blood pressure, temperature and pain assessment.
What information to share
The amount of detail depends on the request, but the HAS guide gives a useful inventory. The caller can provide the admission date and diagnosis, relevant history, invasive procedures or examinations, current treatments, known allergies, relevant results, the patient’s usual state and the duration of the current evolution.
On the receiving side, the HAS regulation sheet explains how a call is analyzed: it relies on the reason for the call, its context, the signs and symptoms described, and the patient’s history, requests and expectations. The regulating physician then qualifies the request and, where possible, forms one or more diagnostic hypotheses. A caller who supplies these elements up front shortens that analysis.
Clinical and administrative information
Two categories travel differently:
- Clinical information: diagnosis, results, treatments, assessment. It is shared in the patient’s interest, with the patient’s consent, and only with professionals involved in care.
- Administrative information: appointment times, contact details, the name of the referring physician, the practice’s address. It can circulate more freely.
Article R4127-45 of the code of medical ethics states that, at the patient’s request or with consent, the physician transmits to colleagues involved in the care the information and documents useful for continuity of care. The sentence frames what to say on the phone: what is useful, to those who care for the patient.
Identity verification
Before any clinical information is given, the person at the other end must be identified. This applies to colleagues and to patients calling back. A page on clinic-ready identity verification by phone describes how a reception team can handle this step without slowing the call.
Coordinating urgent cases and follow-up
A referral does not end when the call ends. The HAS describes medical regulation as a sequence: gathering information, the physician’s decision, implementation, monitoring of interventions or advice, consideration of the effector’s report, orientation of the patient and preparation of the reception. The same logic fits a practice-level referral.
Follow-up is defined in the same HAS document: when an effector intervenes, it is ensured by telephone or computer link; when only advice is given, by phone with the patient or entourage, according to modalities set by the regulating physician and recorded in the file.
Supporting documents for emergencies
For vulnerable patients, the HAS Dossier de liaison d’urgence (DLU) is designed to improve the transfer of information needed by the physician intervening in an emergency, and it also supports the telephone exchange between the caregiver and the SAMU-Centre 15. The same page states that a DLU must be accessible 24/7 to the caregivers who may handle an emergency, and that a liaison letter is sent to the attending physician by the physician who signed the discharge. Having it at hand while calling saves the minutes that are otherwise spent searching for the history.
Back to the attending physician
Within the coordinated pathway, the specialist to whom a patient is oriented, called the médecin correspondant, keeps the attending physician informed and, with the patient’s agreement, transmits the elements needed for coordination, such as examination results or operative reports. A short phone call after a significant consultation, followed by the written report, closes the loop. The practical content of such reports is covered in a page on telephone consultation reports.
Teleconsultation and referral conditions
When the referral leads to a teleconsultation reimbursed by health insurance, specific conditions apply. According to a CMS legal guide, the patient must have been referred by the attending physician where the latter does not carry out the teleconsultation, and must have had at least one face-to-face consultation with the professional in the previous 12 months. The reception team should therefore ask about these elements when scheduling.
Documentation and confidentiality
A telephone exchange is a professional act and is documented as such. The Académie nationale de médecine advises that physicians record telephone exchanges like consultations, preferably with a timestamp. The FMC-HGE adds, in a text on medical liability, that every interaction with the patient should be recorded and traced, including verbal explanations and consent, which becomes decisive if a complaint arises.
A minimal telephone note contains:
- date and time of the call;
- caller and recipient, with function;
- patient concerned;
- information given and decision reached;
- next step, owner and deadline.
Professional secrecy
Article R4127-4 of the Public Health Code provides that professional secrecy, established in the interest of patients, covers everything that has come to the physician’s knowledge in the exercise of the profession, not only what was confided but also what was seen, heard or understood. A call taken in a waiting area or a shared office can therefore breach confidentiality even if no one intends it. The Académie nationale de médecine notes that speaking directly to the patient allows better respect of confidentiality, including for a physician who may be called while with another patient. The rules for French practices are developed in a page on patient call confidentiality.
Choosing the channel
The FMC-HGE states that no medical information should be sent through new unsecured tools such as SMS, WhatsApp or email; only administrative information should travel that way. After a referral call, the written confirmation should therefore follow a secure route. When a call has to be handed from the reception to a clinician, the practice can rely on a defined secure call transfer procedure.
Advice given by phone outside a formal telemedicine framework is not exempt either. An analysis presented at the Assises de l’infectiologie states that, inside or outside telemedicine, consent, professional secrecy and traceability obligations remain similar.
The role of the practice’s reception
Most referral-related calls do not begin with a physician. They begin with a patient who wants to know whether the specialist has accepted the request, a colleague’s secretary who needs a date, or a caregiver who is unsure whom to call. How the reception handles those first minutes determines whether the physician is interrupted for the right reasons.
Several reception practices support a clean referral flow:
- a short list of questions asked in a fixed order, so that the reason for the call is qualified the same way every time;
- clear rules on which calls are put through immediately, which are scheduled for a callback and which are redirected;
- an after-hours protocol, such as the one described in a page on after-hours call triage for French practices;
- an on-call handoff process with a defined pilot period, described in a paste-ready on-call handoff process;
- agenda rules that keep slots available for referred patients, as in five medical scheduling rules and a one-week pilot plan.
Specialty practices in particular receive referral requests continuously. The benefits of phone triage for medical specialty practices include a better distribution of urgent and routine requests, and a page on the evening and weekend medical phone service explains to patients what to expect outside opening hours.
A worked example
A general practitioner sees a patient with a recent change in symptoms and wants a cardiology opinion within the week.
- Preparation. The physician notes age, date of birth, current treatments, allergies, the latest electrocardiogram result and a one-sentence reason.
- Call. The cardiologist’s secretary answers, verifies who is calling and puts the call through, or takes the elements for a callback. The physician follows Saed: situation, history, assessment, request (an appointment within seven days).
- Decision. The recipient proposes a slot and asks for the ECG to be sent. The physician restates the plan.
- Confirmation. The ECG and the referral letter travel by a secure channel, not by consumer messaging.
- Record. The physician notes the call with its time and the agreed plan.
- Follow-up. After the consultation, the specialist informs the attending physician, who updates the file.
Nothing here is complicated. The value lies in doing every step each time, including when the day is busy.
Perspective
After more than fifteen years in medical telephone answering, our observation is that referral problems rarely come from a lack of clinical competence. They come from information that arrives incomplete, calls that reach the wrong person, and requests that nobody follows up.
This is why we consider the telephone a filtre intelligent: a first stage that qualifies the reason for the call, verifies identity, checks the agenda and routes the request to the right professional at the right moment. Our operators are trained specifically for the medical sector, and our service connects with the calendar platforms that practices already use, so that a referred patient is given an appointment without a series of callbacks.
We believe that externalizing reception does not mean distancing the practice from its patients. Properly organized, with confidentiality rules and escalation protocols agreed in advance, it gives the physician back the time needed for the calls that require a physician, and gives patients a consistent, professional answer at any hour.
Rudolph Thierry
How ClicFone supports practices handling referrals
ClicFone provides outsourced medical and paramedical telephone answering for general practitioners, specialists, paramedical professionals and health center teams. Qualified human tele-secretaries, supported by AI for round-the-clock availability, take calls, schedule appointments in the practice’s calendar, coordinate patient calls and handle medical emergencies according to the protocol defined with each practice. The service is designed to respect medical confidentiality and data protection standards.
Practices that want to see how this fits their own referral flow can discover the ClicFone remote tele-secretary service, or start from the phone triage safety principles used to qualify calls.
FAQ
Can a referral be made by phone only, without a letter?
In urgent situations, the first request is often made by phone, and the decision cannot wait for a document. A written trace should still follow, by a secure channel, and the telephone exchange itself should be recorded in the file. Article R4127-45 of the code of ethics frames what is transmitted: information useful for continuity of care, with the patient’s consent.
What should be said first on a referral call?
The caller states their identity and service, then the patient’s identity and location, then the reason for the call in a concise form. This is the Situation step of the HAS Saed method. The history, the assessment and the precise request follow in that order.
Can patient information be sent by SMS or WhatsApp after the call?
According to the FMC-HGE, medical information should not be sent through unsecured tools such as SMS, WhatsApp or email; only administrative information, such as an appointment time, should be. Clinical documents should go through a secure channel agreed between the professionals involved.
Does a telephone referral need to be recorded in the patient file?
Yes. The Académie nationale de médecine recommends recording telephone exchanges like consultations, preferably with a timestamp. The note should contain the caller, the information given, the decision and the next step, which also protects the practice if a question arises later.
Who should answer referral-related calls in a busy practice?
A trained reception, in-house or outsourced, can answer the first call, verify identity, qualify the reason and organize the appointment. Calls that need a clinical decision are put through to the physician or scheduled for a callback according to rules defined in advance.
Sources
- HAS, guide to facilitate communication between health professionals (Saed)
- HAS, medical regulation summary sheet (2011)
- HAS, medical regulation in two clicks
- HAS, Dossier de liaison d’urgence (DLU)
- Service-public.fr, attending physician and coordinated care pathway
- MSA, choosing and declaring an attending physician
- Académie nationale de médecine, the telephone in medical practice
- ARS Île-de-France, emergency guidance
- Légifrance, Article R4127-4 of the Public Health Code
- Conseil national de l’Ordre des médecins, code of medical ethics
- FMC-HGE, medical liability case studies
- Assises de l’infectiologie, telephone advice and the law
- CMS, digital health apps and telemedicine in France
Recommended
- Patient Call Confidentiality: Rules for French Practices
- Telemedicine Phone Screening: Safe Protocols for French Practices
- After-Hours Call Triage: A Protocol for French Practices
- Secure Call Transfer for Medical Practices in France
