Referral from GPs to specialists
Why do GPs r
efer patients t
o specialists?
Distribution of reasons for refer
ral
•
•
•
•
•
•
•
•
Diagnosis
Special investigation
Specific treatment or op.
Advice on management
Specialist management
Reassure GP
Reassure patient/ family
Other
28%
7%
35%
14%
9%
2%
2%
2%
Dangers of
over-referral a
nd under-refer
ral
Dangers of inappropriate or e
xcessive referral
Incorrect labelling
• Collusion of anonymity
•
(Balint M. The Doctor, his Patient and the Illness)
Somatic fixation
• Deskilling of the GP
• Deskilling of the specialist
•
Dangers of insufficient referr
als
•
•
Deprive patients of benefits of high-tech
medicine
Deterioration of patient’s condition - pe
rhaps to point where treatment become
s
• more hazardous
• less beneficial
• futile
•
Lose touch with medical developments
What is an appropriate referr
al?
•
Appropriate to whom
• specialist
• GP
• patient
•
What will be gained
• health gain
• prevention of health loss
• social gain
Contents of re
ferral and disc
harge letters
Contents of the referral letter
- I (ideal)
•
•
•
•
•
•
•
Name, address, dob(age) of patient
Presenting complaint/ problem
History of presenting complaint
Past medical history
Current (& ? Past) medication(s)
Allergies (if any)
Social history (relevant - esp. carers)
Contents of the referral letter
- II (ideal)
•
•
•
•
•
Findings on examination
Results of any investigations
Your opinion of problem/ diagnosis
Reason for referral
Any specific information/ service need
ed from specialist
Contents of the discharge letter (
ideal)
•
•
•
•
•
•
•
•
•
Summary of symptoms
Examination findings
Results of investigations
Diagnosis or summary of problem(s)
Management plan
Nature and quantity of drugs issued
Information given to patient and/or relatives
Follow up arrangements
Advice of future management
Alternatives to referral
•
•
•
•
•
Telephone consultation
Domiciliary visit
Specialist outreach e.g liaison psychiatr
y
Joint consultation
Tele-medicine