Query re need for referral letter

Ghostswimmer

Just curious as to why one needs a GP referral letter for something (e.g. liver ultrasound) if one decides to go through the private system?

Surely if you are consumer and want a scan done, then you pay for it and not have to go through the GP system. If the argument that will be coming back on the replies revolve around the requirement for a Dr. to have a look at you first, well then the question can equally be applied to:

Why need a referral letter to see a consultant, if going private?

Waiting times will still remain, regardless of GP letter or not, the only extra step is having to see a GP in order to get to the consultant in the first place (and of course the extra cost of the GP).

Thanks.

DrIndy

The reason you need a GP referral is so that you are sent appropriately to the best suited consultant to treat you.

Patients may think they have something serious which it most definitely is not and a GP can deal with it, but more importantly - a patient may have minimal symptoms like weight loss and anaemia that tend to get minimised and an astute GP decides to refer.

GPs serve a very important role in the health service and this is why they exist.

Regarding scans - the report needs to be sent back to a doctor for review. Scans do not diagnose contrary to what many people think (many chest x-rays are pretty impossible to interpret but patients feel reassured they got a chest x-ray which justifies their cough, ie it was serious enough to need a chest x-ray and get shirty when they don't get one as clearly the doctor does not appreciate how serious their cough is)

Scans help to rule in and rule out stuff based on a clinical scenario and hence you need to see a doctor first. Also the result needs to be interpreted in the context of the original problem/question so this also means the doctor has to see you again with the result.

Even follow on scans for prior diagnosis are the same thing - if the changes are subtle, it is not possible for a radiologist to say definitively what is going on, simply on foot of the result and hence the original clinician interprets what the subtle changes actually mean.

fifofum

Ah, but the medical profession tend to treat people as patients (I need), not consumers (I want)
And as a patient, how can you know for sure that you need a liver ultrasound? Or if you're even referring yourself to the right consultant? Or if your symptoms are the cause or the effect?

By immediately seeing a consultant privately, off your own bat, you're potentially wasting their valuable time that could have been spent treating patients in greater/more urgent need.
If you ARE in the right place& seeing the right consultant, well then, them having a GP referral letter outlining all the relevant details saves 10-20minutes per patient of taking (questioning, writing notes, ect ect) a full medical history of the complaint. Freeing them up to see more patients during the day. Reducing said waiting list.;)

AmcD

Ok, so you got the private liver ultrasound like you wanted. The report says "diffusely echogenic echotexture". What will you do with the result?

fifofum

Why, consult Dr Google (like I just did!), of course:D

Ghostswimmer

ha ha. Thanks for the responses. I especially like the one with wasting their valuable time...that we pay for.

I just find it strange that if it is a private system one is going through, it doesn't matter really, whether you need an opinion on if one should have a test done or not. Your money, your decision. It is done that way in other european health systems that I have encountered.

And just to clarify a couple of points, I do appreciate the GPs are valuable resources in the system. Secondly, specifically in relation to the the helpful and extremely assumptive post by AmcD, I never mentioned anything about interpretive aspect of results, I was simply referring to obtaining a service. Just to make an example, in some continental european countries, you get your results given to you, in full, and you, as the patient, bring these results along to a qualified person to interpret them. The results are not given directly to the GP, which also ensures the patient can seek multiple views without any hassle/beaurocracy.

ORLY?

Ghostswimmer wrote: »

I just find it strange that if it is a private system one is going through, it doesn't matter really, whether you need an opinion on if one should have a test done or not. Your money, your decision.

It's not strange at all, this is healthcare you're talking about, it's not like any other private service. Legislation and ethical codes dictate that doctors have legal and ethical obligations to look out for the best interests of the patient. Doctors can and should refuse to do tests or other procedures that they deem unecessary, to protect the patient from unneeded pain or discomfort or even the risk of death, which small as it usually is, is a risk that alot of medical procedures carry, and also to protect their own time so that they can use it to treat other patients who are in more need. Instead of bowing to the patients insistence on certain procedures it's more in the patients interest if the decision not to carry out the procedure is properly explained to the patient.

Of course a patient is free to go off to another doctor who may have a different opinion and feel that the procedure is valid, but carrying out unecessary procedures just because the patient can afford to pay for them is not a practice that should be allowed.

Ghostswimmer wrote: »

in some continental european countries, you get your results given to you, in full, and you, as the patient, bring these results along to a qualified person to interpret them.

Really? So the patient could just go to the internet and try to interpret the results themselves, misinterpret them and end up not appropriately acting on them or getting overly anxious or depressed over them, etc. That's just negligent.

Echani

Ghostswimmer wrote: »

ha ha. Thanks for the responses. I especially like the one with wasting their valuable time...that we pay for.

Whether you're paying for it or not, their time is limited and there may be a lot of patients who need it more urgently.

sam34

Ghostswimmer wrote: »

Why need a referral letter to see a consultant, if going private?

because teh patient, as a lay person, will not necessarily know which specialist they need to see


if you have abdominal pain, you may need to see any one (or more) of teh following:

general surgeon
hepatologist
cardiologist
nephrologist
orthopardic surgeon
general physician
gynaecologist
urologist
anaesthetist/pain specialist
psychiatrist
endocrinologist

and thats not an exhaustive list!

the role of the gp is to ascertain who best you need to see and to elicit other symptoms or lack thereof that make your case urgent or routine

AmcD

Ghostswimmer wrote: »

And just to clarify a couple of points, I do appreciate the GPs are valuable resources in the system. Secondly, specifically in relation to the the helpful and extremely assumptive post by AmcD, I never mentioned anything about interpretive aspect of results, I was simply referring to obtaining a service. Just to make an example, in some continental european countries, you get your results given to you, in full, and you, as the patient, bring these results along to a qualified person to interpret them. The results are not given directly to the GP, which also ensures the patient can seek multiple views without any hassle/beaurocracy.

I don't mean to come across as assumptive about your intentions for getting an ultrasound, but if you get a test done, you will get results. It is important to know what you will do with the results. Not everything gets reported as completely normal.

Medical tests are different from other "services". They are not done in isolation. To make sense of results the person's medical history and symptoms should be considered along with test results.

Ghostswimmer

ORLY? wrote: »

It's not strange at all, this is healthcare you're talking about, it's not like any other private service.

If it is a private service, it is a private service. Not being flippant or ignorant of ethical issues or otherwise, but you are paying for their time out of your pocket. If this was public sector, then fair enough. But I'm talking about professionals that are being paid by private individuals.

ORLY? wrote: »

Doctors can and should refuse to do tests or other procedures that they deem unecessary, to protect the patient from unneeded pain or discomfort or even the risk of death, which small as it usually is, is a risk that alot of medical procedures carry, and also to protect their own time so that they can use it to treat other patients who are in more need..

Ethically, if a patient deems it necessary to get something done, with full knowledge of said discomfort/pain, such as blood test or scan or whatever, within reason, would it not be unethical not to carry out a patients wishes? Risk of death is something that is assumed with some procedures, but yet perceived benefits are the main factors in influencing decision. Those perceived benefits are whose, exactly? Patients are always given the choice to have something performed or not, and sometimes they choose not to, regardless of perceived benefits from one viewpoint.

Referring to the point on protect their own time to treat other patients. Well, as I said, that is fair enough if in public system. Not in a private situation. Plus, there is a waiting time in private system too, so obviously doctors prioritise in this system too.

As an adjunct, how many cases have we all read about, in general public literature and also in clinical journals where the patient demands a procedure (such as a scan), that the busy doctor had deemed unnecessary, an dproven that the patient was right to vehemently state their cases? Thus, the point made above holds a little less water.

ORLY? wrote: »

just because the patient can afford to pay for them is not a practice that should be allowed.

Yet it is universally accepted...private medicine.

ORLY? wrote: »

Really? So the patient could just go to the internet and try to interpret the results themselves, misinterpret them and end up not appropriately acting on them or getting overly anxious or depressed over them, etc. That's just negligent.

Absolutely correct. Spanish healthcare system, as an example, is one of such systems. You get tests done, get your results given to you, and then you go to another doctor to have them interpreted. I appreciate the pitfalls of this situation, as you have pointed out. However, it exists.

I do appreciate the points that most are putting forward. However, I suppose what I am trying to say is that, in other jurisdictions, you enter the healthcare building, you make a request, a professional sees you (almost like a screening person), refers you to a test (or several) if appropriate and then you get tests done and results given to you. Often, the person giving you the results can interpret them for you there and then, if you want to (Caveat: this is a private system). Whilst I am cogniscant of the fact that a person as reviewed your status, similar to the role of a GP in this instance, you don't have to waste time with the GP.

This fundamentally differs from this country because here, you must go to a GP first, get a letter sent to another professional, put on a list, eventually get tests done, results go back to GP, you revert to GP and get results interpretted to you (Caveat: this is a private system).

In scenario A, you get everything done in 1 day and location. In scenario B, it is a much more protracted situation. The main difference seems to be the GP system. And just in case some people think scenario A is the assumptive "ideal state", it is not, and does exist in other jurisdictions.

Ghostswimmer

sam34 wrote: »

the role of the gp is to ascertain who best you need to see and to elicit other symptoms or lack thereof that make your case urgent or routine

I accept your points in this post. Except the last one. Are you saying that the GP's role is to deem how fast you are seen to or not, even though they are not a specialist in the area (given that you have to be referred to a specialist)?

This seems a bit illogical. You are being sent to a specialist to deem your place on the list. The specialist should be able to do this, and out of the remit of a GP. If it is not and the GP does this, what is the point? Assuming the specialist will have vast more knowledge of the area than the GP.

sam34

Ghostswimmer wrote: »

I accept your points in this post. Except the last one. Are you saying that the GP's role is to deem how fast you are seen to or not, even though they are not a specialist in the area (given that you have to be referred to a specialist)?

This seems a bit illogical. You are being sent to a specialist to deem your place on the list. The specialist should be able to do this, and out of the remit of a GP. If it is not and the GP does this, what is the point? Assuming the specialist will have vast more knowledge of the area than the GP.

GPs are the gatekeepers for access to consultants. there is no point in a gp sending a bland "generic" referral letter, that is no help to the consultant who has to prioritise appointments.

the gp can elicit certain symptoms and signs and pass that information on

eg, look at the difference between the following three cases:

"please see this man with abdominal pain"

"please see this 72 yr old man with abdominal pain, weight loss, altered bowel habit, anaemia and abnormal liver function tests"

"please see this 72 year old man with abdominal pain. Routine bloods all normal, no weight loss or change in bowel habit. physical exam unremarkable"


a good referral letter and initial work up will help the consultant decide who needs to be seen urgently and who can wait for a routine appointment

lonestargirl

Ghostswimmer wrote: »

Ethically, if a patient deems it necessary to get something done, with full knowledge of said discomfort/pain, such as blood test or scan or whatever, within reason, would it not be unethical not to carry out a patients wishes?

Well to take a CT scan / x-ray for example, the doctor sending you for a scan and the radiologist performing the scan are both legally resposible for the ionising radiation exposure that you receive. They must be able to justify it on a demonstrated risk/benefit basis not the perceived risk/benefit that the patient sees.


As a personal example if I walked into a clinic and they checked my blood my ferritin level could possibly be below normal. However they would have no context for this piece of information, my GP would know that my ferritin level today is higher that it was last time and this upward trend is what's important.