Why do I need to see a GP for a referral?

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Dr Murray James-Wallace is a procedural GP and principal at the Panaceum Group.

“Can anyone tell me why we need to see a GP every year to get referrals for ongoing medical issues? … It just seems wrong needing a new referral when we have to see specialists regularly for monitoring of chronic conditions.”

This is a great question frequently borne from frustration and not a topic briefly or easily well explained. I hope you’re able to discuss these queries with your GP. The referral system is an entrenched part of our healthcare system. One does not actually need a GP referral to see a specialist in Australia, however if the patient requires Medicare to pay them a rebate to assist covering the cost when visiting a specialist, a GP referral needs have been obtained by the patient first.

Why do I need to see a GP for a referral?In Australia and other Commonwealth countries in particular the GP referral system is a kind of triage system, so that patients see the appropriate specialist at the appropriate time (resources allowing). It’s not perfect but it is viewed as an efficient system. In places like the USA patients wander off direct to specialists in many instances and its thought to lead to inappropriate and higher care cost with reduced access for many people with reduced means. Imagine if everyone one with itchy eyes swamped the local ophthalmologist.

I can appreciate the frustration with repeat referrals however, again the need for ongoing higher cost, tax payer funded specialist review needs to be reassessed. There is a legal and most importantly medical reason to make sure that past medical history, allergies and current medications are correctly relayed to the specialist.

People with chronic diseases (a disease lasting longer than a month or so) may be seeing several specialists and have had several investigations and your GP should be synthesizing a summary to be relayed in the referral. This liaising between specialist and GP often goes on after hours and behind the scenes, on an ongoing basis long after the initial referral and attendance.

Lastly the referral requires the specialist to write a diagnosis and management plan back to the referring GP (sometimes on several occasions), countless times patients return to their GP to get a better understanding of what the specialist said, and often the GP coordinates the treatment plan. A referral to say an orthopaedic surgeon could result in the GP receiving many specialist updates, imaging, blood tests, and instructions for suture removal etc.

Follow up lasting over several months, each piece of the puzzle being carefully archived by the GP, so that when e.g. diarrhea occurs, the relevant details can be forwarded to the unsuspecting specialist gastroenterologist who at first fails to see the link between the psychiatrist who assessed the drinking problem, that led to the fall that broke the bone that led to the Richards Screw and Plate that got infected, that needed antibiotics which caused the diarrhea. GPs often see the big picture.

Certainly most people are able to manage matters like remembering their health issues and medications themselves, but people do become unwell and stressed. People aren’t stupid, that’s why I get my car serviced by people who know which way round a spark plug goes and how often they should, trust trumps cynicism.. : )