{"id":20623,"date":"2024-08-28T09:01:55","date_gmt":"2024-08-28T08:01:55","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=20623"},"modified":"2026-06-26T13:40:25","modified_gmt":"2026-06-26T12:40:25","slug":"general-medicine-elch","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/generalmedicine\/general-medicine-elch\/","title":{"rendered":"General Medicine ELCH"},"content":{"rendered":"\n<p class=\"has-alert-red-color has-text-color has-link-color wp-elements-77f526c7ab102de5257f74087a10b80d wp-block-paragraph\"><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-standard-black-color\">The following guidelines are aimed at ensuring effective and efficient use of services, so that patients get seen promptly in the \u2018right place by the right person, the first time.<\/mark><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Sometimes we review patients in the General Medical Outpatient Clinic and then refer directly on to another more appropriate specialty.&nbsp; We recognise that this decision is often not clear cut at time of referral and that these onward referrals are sometimes inevitable because of the complex nature of our caseload and the type of service we provide.&nbsp; These guidelines have been devised to help this process and hopefully allow the most appropriate referrals from the outset.&nbsp; We are always happy to discuss grey areas and complex cases.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Our Services<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>General medical clinics<\/strong>&nbsp;are held in East Lothian Community Hospital. We aim to see urgent referrals within two to four weeks. <strong>Routine<\/strong>&nbsp;referrals are seen within the 12 week guarantee.<br>&nbsp;<br><strong><u>More urgent referrals<\/u><\/strong>&nbsp;(e.g. rapid deterioration in a patient\u2019s condition), which may require inpatient assessment should be referred for assessment via the&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/admissionsurgentcare\/flow-navigation-centre\/\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>Flow Navigation Centre<\/strong><\/a> for admission to RIE or WGH. ELCH does not accept direct General Medicine referrals.<\/p>\n\n\n\n<p class=\"has-alert-red-color has-text-color has-link-color wp-elements-a8164ccea74fd5a923ded9be4307c41f wp-block-paragraph\"><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-standard-black-color\">Any cases that are not clear cut or require a second medical opinion can always be discussed with:<\/mark><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/general-medicine-urgent-referrals\/\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>General Medical Interface Team consultant on-call<\/strong><\/a>, available in the Emergency Department of the RIE or via the RIE switchboard, all working weekdays 8am to 8pm, or<\/li>\n\n\n\n<li>On-call consultant for General Medicine at RIE at weekends or bank holidays via switchboard<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><u>General Medical Advice Service<\/u><\/strong><strong>: &nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">We have set up an Advice only referral pathway via SCI Gateway for General Medicine at ELCH. We aim to respond within seven working days.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">JH &amp; JB 26\/6\/26<\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\"><strong>How to refer:<\/strong><\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">All referrals are best sent via SCI Gateway:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>FOR ADVICE ONLY: <\/strong>East Lothian Community Hospital &gt;&gt; General Medicine &gt;&gt; Advice Only<\/li>\n\n\n\n<li><strong>FOR OUTPATIENT APPPOINTMENT: <\/strong>East Lothian Community Hospital &gt;&gt; General Medicine &gt;&gt; Basic Sign Referral<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>(For admissions \/ same day urgent assessment then referral should be Flow Navigation Centre to RIE \/ WGH).<\/strong><\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Who to refer:<\/strong><\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">It is appropriate to refer patients with:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Weight loss<\/strong>&nbsp;without specific features to suggest a particular sub-specialty referral, after appropriate initial investigations<\/li>\n\n\n\n<li><strong>Multisystem symptoms<\/strong>&nbsp;and\/or&nbsp;<strong>abnormal blood results<\/strong>&nbsp;with an unknown diagnosis, despite appropriate initial investigations<\/li>\n\n\n\n<li><strong>Raised Inflammatory markers<\/strong>&nbsp;with&nbsp;<strong>multiple constitutional symptoms<\/strong>, not suggestive of an underlying rheumatological or infectious disease process<\/li>\n\n\n\n<li>Patients who require a&nbsp;<strong>second medical opinion<\/strong><\/li>\n\n\n\n<li><strong>Normochromic normocytic anaemia&nbsp;<\/strong>with<ul><li>no clear underlying cause despite appropriate initial investigations&nbsp;<strong>AND<\/strong><\/li><\/ul>\n<ul class=\"wp-block-list\">\n<li>who&nbsp;<strong>do not<\/strong>&nbsp;meet criteria for <strong><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/haematology\/anaemia\/anaemia-normocytic\/\" target=\"_blank\" rel=\"noreferrer noopener\">Haematology referral<\/a><\/strong><\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Syncope or pre-syncope<\/strong>&nbsp;where the presumed cause is&nbsp;<strong>orthostatic hypotension, situational syncope&nbsp;<\/strong>or<strong>&nbsp;vasovagal syncope<\/strong>, which is&nbsp;<strong>frequent or persisting<\/strong>&nbsp;despite conservative management&nbsp;<strong>AND<\/strong>&nbsp;where&nbsp;<strong>cardiogenic or neurological<\/strong>&nbsp;causes<strong>&nbsp;have been<\/strong>&nbsp;<strong>excluded or are thought to be unlikely.<\/strong>&nbsp; See \u2018Who Not to Refer\u2019 section for details.<\/li>\n\n\n\n<li><strong>Palpitations\u00a0<\/strong>in patients with\u00a0<strong>no<\/strong>\u00a0obvious endocrine cause and\u00a0<strong>who do not\u00a0<\/strong>meet referral criteria for <strong><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/cardiology\/arrhythmia-and-palpitations\/\" target=\"_blank\" rel=\"noreferrer noopener\">Cardiology Referral<\/a><\/strong><\/li>\n\n\n\n<li><strong>Dizzy spells<\/strong>\u00a0in patients who are generally under the age of 65 years with\u00a0<strong>no obvious<\/strong>\n<ul class=\"wp-block-list\">\n<li>ENT cause \u2013 generic ENT: a specific pathway for dizziness is currently under development<\/li>\n\n\n\n<li><strong><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/cardiology\/arrhythmia-and-palpitations\/\" target=\"_blank\" rel=\"noreferrer noopener\">cardiac cause<\/a><\/strong><\/li>\n\n\n\n<li>neurological cause<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">We recognise that there are many patients who are over the age of 65 years who are fit and independent with few comorbidities and often a general medical referral is appropriate for them.&nbsp; Those over the age of 65 with multiple comorbidities and multifactorial conditions (e.g. dizziness, falls, non-specific symptoms) are better assessed by <strong><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/moeeastlothian\/\" target=\"_blank\" rel=\"noreferrer noopener\">Medicine for the Elderly ELCH<\/a><\/strong><\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Who not to refer:<\/strong><\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Patients&nbsp;<strong>known to (or who have already been referred to)<\/strong>&nbsp;<strong>other services<\/strong>&nbsp;and have ongoing specialty specific issues.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Patients with <strong>organ specific complaints<\/strong> e.g. poorly controlled asthma, should be referred to the <strong>relevant organ specialty<\/strong> and not General Medicine. Please note that not all specialties offer clinics in East Lothian so you may need to refer to RIE or WGH. In the case of symptoms such as breathlessness where the most appropriate specialty is not clear, please initiate appropriate tests from primary care such as CXR, NT-Pro-BNP, ECG etc and only refer to General Medicine if the diagnosis is still unclear.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Patients with&nbsp;<strong>rapidly declining symptoms<\/strong>. &nbsp;Please consider&nbsp;<strong>admission&nbsp;<\/strong>or discuss with the Medical Interface Team consultant on-call (available via switchboard) or the on-call Consultant for General Medicine (on weekends or bank holidays).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Allergy Issues<\/strong><\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li>There is currently no allergy service in NHS Lothian.<\/li>\n\n\n\n<li>Please see this link re <strong><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/immunology\/\" target=\"_blank\" rel=\"noreferrer noopener\">Allergy testing guidance<\/a><\/strong><\/li>\n\n\n\n<li>Dermatology colleagues may sometimes assess patients and offer skin prick tests, but&nbsp;<strong>NOT<\/strong>&nbsp;provocation testing, de-sensitisation or immunotherapy: see <strong><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/dermatology\/urticaria\/\" target=\"_blank\" rel=\"noreferrer noopener\">Urticaria page<\/a><\/strong><\/li>\n\n\n\n<li>Otherwise consider an out of area referral, which can only be done by secondary care.<\/li>\n<\/ol>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Primary Immune Deficiency<\/strong>&nbsp;and&nbsp;<strong>C1 inhibitor deficiency (hereditary angioedema)<\/strong>&nbsp;\u2013 refer to Immunology<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Chronic&nbsp;&nbsp;fatigue&nbsp;<\/strong>\u2013 please see guidance on <strong><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/rehabilitation\/chronicfatiguesyndromeme\/\" target=\"_blank\" rel=\"noreferrer noopener\">Chronic Fatigue Syndrome page<\/a><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Night Sweats \u2013 patients with:<\/strong><\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>abnormal FBC<\/strong>&nbsp;\u2013 please refer to Haematology<\/li>\n\n\n\n<li><strong>normal FBC<\/strong>&nbsp;\u2013 please consult RefHelp guidelines for <strong><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/nightsweats\/\" target=\"_blank\" rel=\"noreferrer noopener\">night sweats<\/a><\/strong> and consider referral to appropriate specialty<\/li>\n<\/ol>\n\n\n\n<p class=\"wp-block-paragraph\">We are amenable to reviewing patients who have night sweats in the context of normal FBC and constitutional symptoms that suggest a <strong>non-haematological malignancy<\/strong>. &nbsp;Please ensure that the recommended primary care investigations are followed prior to referral<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Syncope likely to be \u2013<\/strong> <strong><em>Cardiogenic cause<\/em><\/strong>&nbsp;\u2013 refer to Cardiology.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Suspect if:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Abnormal ECG: symptomatic heart block, bradycardia &lt;40bpm, pauses &gt;3s, AF, LVH changes, Q waves suggestive of IHD or cardiomyopathy, conduction abnormalities, BBB, long or short QTc<\/li>\n\n\n\n<li>Structural or ischaemic heart disease or heart failure<\/li>\n\n\n\n<li>Syncope while supine<\/li>\n\n\n\n<li>Syncope on exercise (nb syncope after exercise is often vasovagal)<\/li>\n\n\n\n<li>Syncope without prodrome (esp. &gt;65yrs)<\/li>\n\n\n\n<li>Syncope preceded by palpitations&nbsp;<\/li>\n\n\n\n<li>Family history of sudden cardiac death<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><br>Syncope likely to be &#8211; Neurological cause<\/strong>&nbsp;\u2013 primarily seizures disorders: <strong><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/firstseizuresandepilepsy\/\" target=\"_blank\" rel=\"noreferrer noopener\">Refer to general neurology or first seizure clinic<\/a><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Palpitations<\/strong>&nbsp;with a likely&nbsp;<strong>endocrine<\/strong>&nbsp;or<strong>&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/cardiology\/arrhythmia-and-palpitations\/\" target=\"_blank\" rel=\"noreferrer noopener\">cardiac&nbsp;<\/a><\/strong>cause.&nbsp; Refer to appropriate specialty.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>General Gastrointestinal presentations<\/strong>&nbsp;e.g., microcytic anaemia, diarrhoea, altered bowel habit, dysphagia and dyspepsia \u2013 Please see <strong><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/gastrointestinal\/\" target=\"_blank\" rel=\"noreferrer noopener\">Gastroenterology guidance<\/a><\/strong><br><br><strong>Generalised musculoskeletal pains<\/strong>&nbsp;polyarthralgia, polyarthritis, and muscle stiffness \u2013 Please see <strong><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/rheumatology\/\" target=\"_blank\" rel=\"noreferrer noopener\">Rheumatology guidance<\/a><\/strong><\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Alternatives to Admission:<\/strong><\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">There is always a&nbsp;<strong>General Medical Interface Team consultant<\/strong>&nbsp;who operates out of Accident &amp; Emergency at the RIE on all working weekdays between 8am and 8pm. &nbsp;We carry an Interface Team mobile phone which can be accessed via switchboard which allows a senior to senior discussion for patients who are not clear cut. &nbsp;We endeavour to either review patients on the same day or advise on whether clinic or ambulatory care, are suitable alternatives to admission.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The <strong><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/admissionsurgentcare\/flow-navigation-centre\/\" target=\"_blank\" rel=\"noreferrer noopener\">Flow Navigation Centre<\/a><\/strong> also helps to support the flow of patients across the acute sites and can discuss alternatives to admission.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Other alternatives are:-<\/strong><\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/admissionsurgentcare\/ambulatorycare\/ambulatorycarerie\/\" target=\"_blank\" rel=\"noreferrer noopener\">Ambulatory Care<\/a><\/strong><\/li>\n\n\n\n<li><strong><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/admissionsurgentcare\/hospital-at-home\/hospitalathomeeastlothian\/\" target=\"_blank\" rel=\"noreferrer noopener\">Hospital at Home<\/a><\/strong><\/li>\n\n\n\n<li><strong><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/respiratory\/east-lothian-community-respiratory-pathway\/\" target=\"_blank\" rel=\"noreferrer noopener\">East Lothian Community Respiratory Pathway<\/a><\/strong><\/li>\n\n\n\n<li><strong><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/cardiology\/rapidaccesschestpainracp\/\" target=\"_blank\" rel=\"noreferrer noopener\">Rapid Access Chest Pain Clinic at RIE<\/a><\/strong><\/li>\n\n\n\n<li><strong><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/neurology\/transientischaemicattacktiaandstroke\/\" target=\"_blank\" rel=\"noreferrer noopener\">Stroke\/TIA Hotline<\/a><\/strong><\/li>\n<\/ol>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>The following guidelines are aimed at ensuring effective and efficient use of services, so that patients get seen promptly in the &lsquo;right place by the right person, the first time. Sometimes we review patients in the General Medical Outpatient Clinic and then refer directly on to another more appropriate specialty.&nbsp; We recognise that this decision<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":3960,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[219,1131],"class_list":["post-20623","page","type-page","status-publish","hentry","category-generalmedicine","category-https-apps-nhslothian-scot-refhelp-general-medicine-elch"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/generalmedicine\/\" rel=\"tag\">General Medicine<\/a><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/generalmedicine\/https-apps-nhslothian-scot-refhelp-general-medicine-elch\/\" rel=\"tag\">General Medicine ELCH<\/a>","rttpg_excerpt":"The following guidelines are aimed at ensuring effective and efficient use of services, so that patients get seen promptly in the &lsquo;right place by the right person, the first time. Sometimes we review patients in the General Medical Outpatient Clinic and then refer directly on to another more appropriate specialty.&nbsp; We recognise that this decision","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/20623","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=20623"}],"version-history":[{"count":7,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/20623\/revisions"}],"predecessor-version":[{"id":28593,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/20623\/revisions\/28593"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3960"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=20623"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=20623"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}