Liam Farrell: The best weapon in a GP's armoury is 'referral'

If I could say one word to GP trainees (sorry, registrars), a piece of wisdom earned at bitter cost during my years of drudgery at the coal-face of general practice, it would be refer, and keep on referring, refer, refer, refer, eight words actually (as Dr Samuel Johnson said, I'm too busy to be brief).

This axiom was distilled through painful experience, because it is quite against my nature. As a young lad, I used to take my responsibilities as a gatekeeper very seriously. By keeping little Jonny at home, some poor old sod might get their hip replacement brought forward by a few days.

There was also a considerable degree of personal and professional pride at stake; my own hard-earned expertise, the expertise of my nursing and paramedical colleagues in primary care, what have they got we haven't, we could handle it.

But the sad truth is that patients like to be referred, and they feel safer and more comfortable in hospital. George Clooney, Dr Kildare, all that big shiny equipment, what could go wrong?

Their relatives, of course, are invariably sad to lose their loved ones, even for a few days, and can be found bemoaning their loss down at the local, singing songs, dancing little jigs of despair, and telling each other funny stories to cover up their terrible grief.

Referral also validates the patient's illness; 'I have to see a specialist' or 'I had to be rushed to hospital' or 'I need a scan' all carry more street-cred than 'He told me there was nothing wrong with me' or 'He said it would get better on its own' or 'He told me I was too fat'.

Most complaints against GPs are for failure to refer. Refer early and you will be the hero; delay and some smart aleck in the hospital is sure to say: 'My god, you have a serious ear infection and you need antibiotics urgently, lucky for you we caught in time. What do you mean you haven't had an X-ray, what was your GP doing?'

Or someone else will slip in and refer your patient. Some GPs are very skilled at this; like great comedy, it's all about timing.

So go ahead, swallow your pride and refer, it's not coming out of your pocket, the patient and relatives are kept happy, and best of all, someone else has to do all the work.

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