This page provides information on radiation therapy for health professionals. Read more on Radiation Oncology Targeting Cancer website. Gynaecologist Dr Janine Manwaring presents a practical framework for the clinical assessment and management of pelvic pain. Read more on Jean Hailes for Women's Health website.
For a person to remain at home as a terminal illness progresses, practical help and increasing care from family and friends is needed. GPs can support caregivers. Read more on CareSearch website. When GPs assess patient's needs their existing co-morbidities, intractable symptoms and complicated social and psychological issues can all increase perceived complexity. Healthdirect Australia is not responsible for the content and advertising on the external website you are now entering.
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What does a referral do? When might I need a referral? What information does a referral include? How long does a referral last?
The analysis was conducted independently by the two main investigators, which resulted in two slightly different sets of codes. At this point, the ongoing analysis was discussed with the other investigators. The two main investigators reviewed again the transcripts independently, taking care to include these aspects they had previously left out. The other investigators validated these results. During the data processing stage, as well as during the data analysis and interpretation stage, the emerging themes were submitted to a feedback group of CGM-GPs.
We went back and forth until we confirmed that our interpretations were going in the right direction. They expressed the feeling that some cases need no further thoughts. For example, we have a patient with typical, uh… chest pain.
When GPs are confronted with these situations, they often feel lost, not knowing how to proceed:. On the one hand, cases in which the decision to refer is difficult to make are linked by GPs to stress and anxiety.
Such remarks reveal that referring is very significant for GPs with regard to how they perceive themselves, as opposed to specialists. So if we are called to act as gatekeepers, to what extent are we supposed to do it or not? More importantly, our study reveals that GPs entertain diverse concerns regarding cases in which they hesitate to refer. These concerns can be classified into three different categories: a concerns about the treatment, b concerns about the patient and the doctor-patient relationship and c concerns about the referring GP himself.
A Regarding the concerns about the treatment , participating GPs indicated that they turn to specialists to optimize medical care when confronted with their own limits theoretical, clinical or practical.
However, GPs also stated that they sometimes use referrals to delegate tasks to specialists in order to concentrate on other aspects of treatment. B The second set of concerns regards the consequences of referring for the patient and for the doctor-patient relationship. While there Participating GPs — especially chief residents — also expressed concern about the possible effects of referrals on their relationship with the patient.
This fact is considered by GPs before referring:. C A third set of concerns regards the possible consequences of the referral for GPs themselves. These factors are evoked by GPs as prompting them to refer. However, they also express the fear that unnecessary or too numerous referrals might be taken as a sign of incompetence by specialists, patients, colleagues or supervisors.
A Regarding the first, GPs indicated that they often get advice before referring, either by soliciting the informal opinion of a specialist they personally know, or in a more formal way by requesting assistance from their supervisor.
Such interactions help them to better comprehend the case at stake simply by describing it to someone else:. Can we wait a little longer before sending to the specialist? Try other treatments, err Eventually, emerges the question of how long can the referral decision be postponed. For example, lately there has been a symposium on gastroenterology about what to do in healthy adult in gastroenterology, so it allows us not to send everyone to gastroscopy… [M: Internal training] Yes, which is really suitable for generalists.
B GPs expressed the need to rely on clear theoretical backgrounds when referring, with guidelines being perceived as supporting and facilitating referral decisions. In this perspective, guidelines appear as an institutional pressure rather than as a decision support tool:. C Finally, chief residents evoked the availability of specialists and the quality of their relationship with them as important for the referral process.
They regretted not benefiting enough from more proximity with the specialists:. We would have a contact that would be different, it would be easier to ask for advice. They underlined that personal relationships with specialists facilitate the referral process and can help them in their decision-making.
The aim of this study was to contribute to a more accurate understanding of how GPs decide to refer their patients to specialists [ 3 , 6 , 7 , 18 ]. To this end, we analyzed two FGs conducted among GPs residents and chief residents working in a university outpatient clinic, located besides the Lausanne University Hospital. Most GPs participating in our study were young clinicians, more than half of them still in residency training.
An important number of patients visiting the clinic have psychosocial vulnerabilities. Nevertheless, they believe that internal guidelines and training help them to feel more confident when deciding to refer or not. The first set of concerns address the issue of adequate treatment and optimal coordination of care.
GPs also reported that they sometimes use referrals in an instrumental way, in order to gain time and room for focusing on other aspects of the patient. Figure 1 below summarizes these findings. Although the need for qualitative studies addressing the referral process has been acknowledged, [ 3 , 7 , 14 ] little research has been conducted so far. The study thus allowed to shed light on what clinicians experience and take into account when deciding whether they should refer patients to specialists or not.
Nevertheless, there are three obvious limitations to our study. First, the perspective we have chosen is general: we did not address one specific type of referral, since referrals to various specialties e. Their inclusion would certainly add to the understanding of the referral process.
A third limitation of this study results from the specificity of the setting. In addition, the CGM treats patients with psychosocial vulnerabilities, in need of multidisciplinary care, who are usually emotionally challenging for GPs [ 1 , 12 , 28 ]. In such a setting, referring to specialists is a central act in providing medical care and strongly preoccupies GPs, a condition that was seen as an advantage for investigating the referral process. In addition, the majority of participating GPs were in training or at an early stage of their career.
We can hypothesize that young GPs with less clinical experience are more preoccupied about how to refer or not to specialists, and that therefore also various physician-related reasons for referral were prevalent.
Accordingly, our setting was a very fertile ground for studying the referral process. By focusing on GPs lived experience, our study contributes to this effort.
It provides a new perspective on the referral process and the associated decision making process, as most researchers have so far addressed this issue by solely scrutinizing the biomedical factors that influence referral. These themes match our own results. First appointments for cancer — that should occur within two weeks of a GP suspecting the disease — are included in some of the targets to cut referrals, the study by Pulse magazine found. The rewards are being offered by clinical commissioning groups CCGs , the NHS bodies responsible for the planning and commissioning of healthcare in their local area.
Some CCGs have argued the incentives represent no conflict of interest for doctors. About the author. He is a GP trainer and undergraduate tutor with special interests in 'Poverty Medicine', shame, trauma and education. He was recently voted the 49th most influential GP in the country by Pulse magazine because of his blog.
See all posts by Dr Jonathon Tomlinson. Latest For Whose Benefit? Site Search Search for:. Support Our Work Our work to promote independent and evidence-based health policy is only possible thanks to the support of individuals like you: Donate. Loading Comments Email Required Name Required Website.
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