Refer, refer and keep referring

I was invited last month to address the GP registrars in Dublin on the occasion of the Manne Berber Memorial lecture.

Manne was our course organiser back in the early 1980s, when GPs were generally considered to be slightly lower in the medical pecking order than a dead hyena. But his enthusiasm, compassion and knowledge could not be kept down, and he remains a great role model for me.

Unfortunately it's one I've had great difficulty living up to. Manne used to have three criteria for what made a good doctor. I've forgotten the first one - it was a long time ago. The second was self-congruity (which means, I think, being yourself) and the third was pure Manne: unconditional positive regard for the patient, which I reckon I lost about halfway through my first surgery.

The registrars were as cute as puppies, keen and optimistic, fresh-faced and innocent. So I felt it wasn't appropriate to rain on their parade and tell them the truth - about the endless demands for sick certs and antibiotics, about the long, dreary, pointless consultations which leave you praying for death.

But I did give them some good advice, based on my own bitter experience.

When I was a young GP, I was too proud. To me at that time, a referral was an admission of defeat. What was the use, I thought, of sending patients to hospital doctors who were either wet behind the ears or senile old fuddy-duddies.

But now that I'm an old fuddy-duddy myself, I know better.

Most complaints received by the medical defence organisations against GPs concern a failure to refer. This is absurd; referrals are brilliant and everybody is a winner. Patients love them, it's more business for the hospital, and, most importantly, we pass the buck.

Then when the patient complains about the waiting list being six billion years long we can throw up our hands in mock sympathy.

Which makes me concerned about some of the other advice our registrars are receiving. A recent advice column asked what you would do if a father brought in his son after a neck injury and requested a physiotherapy referral.

Three experienced doctors were asked to comment, and all gave po-faced and unrealistic advice, going on and on about things like unnecessary referrals, duty of care and giving patients leaflets.

Trust me, grasshopper, refer the kid and save everybody a headache. The father will not be humiliated in front of his son, the kid won't mind, and you'll save a lot of time which can be spent on someone who really is sick. Refuse, and you'll be the one with the pain in the neck.

- Dr Farrell is a GP from County Armagh.

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