Part II. General practitioner–specialist referral process

Abstract

This is the second of two articles that explore the general practitioner (GP)-specialist relationship. In this article, we explore the nature of the referral process, beginning with referrals frequently made by GPs in Australia and reasons for referral to specialists. In Australia, GPs commonly refer patients to specialists, particularly orthopaedic surgeons, ophthalmologists, surgeons and gynaecologists for a variety of reasons, including diagnosis or investigation, treatment and reassurance (reassurance for themselves as well as reassurance for the patient). GPs will choose a specialist after considering a variety of factors, such as the specialist's medical skill, their previous experience with the specialist, the quality of communication between them, office location and patient preferences. The referral is generally made by telephone or by letter, the latter of which is known to vary significantly in content and quality. The specialist, GP and patient expectations of the referral and the consultation process are also described. Specialists expect the GP to provide information about the problem to be addressed and adequate patient history, GPs expect a clear response regarding diagnosis and management as well as justification for the course of action, and patients expect clear communication and explanation of the diagnosis, treatment and follow-up requirements. When these expectations remain unmet, GPs, specialists and patients end up dissatisfied with the referral process.

The Interface of Primary and Oncology Specialty Care: From Symptoms to Diagnosis

“…Primary care providers and patients expect the specialist to provide a clear explanation about the evaluation, diagnosis, and management of the patient (10). Although delays in cancer diagnosis have been mostly attributed to clinician inaction or to reassurance following a false-negative evaluation, patient and system factors also play a role (11,12).…”

Quality assessment of discharge summaries from an emergency department in eastern Nepal

“…Lack of good discharge instruction results in polypharmacy and readmission as shown in studies. 4,5 Incomplete reporting of laboratory tests and results is also a concern as it may cause duplication of the test that has already been performed when patients comes for follow up.…”

Agreement between clinical and histopathologic diagnoses and completeness of oral biopsy forms

“…A close dialogue between clinicians and oral pathologists is clearly desirable, and it is partially dependent on the information provided in referral forms 12 . Incomplete biopsy forms can contribute to the difficulties associated with specimen interpretation and can lead to descriptive or inconclusive reports 38,39 .…”

“…These hypotheses are supported by the incidence of incomplete referral letters or forms that accompany speci men s subm it ted for h istopat holog ical examination. When sufficient information is not provided, it is difficult to achieve an accurate histopathological diagnosis 11,12 .…”