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Healthcare system: Doctor referrals system

  • 27-04-2020 11:02pm
    #1
    larbakium
    Registered Users Posts: 83 ✭✭


    Hello all,
    overall I am trying to understand why it could be hard to get a GP to give a referral letter to a specialist consultation or imaging scan?

    I have been in and heard of multiple situations where a patience is looking for a referral letter from the GP in order to get a scan done or even see a consultant and the GP seems to be reluctant to share one. Also, I feel that GPs try to avoid the public route, promoting the private.

    My post is not to discuss whether this is right or wrong, but instead I am just wondering if this is a common thing or I have just been unlucky. Also, I wonder if GPs have a incentive or limitation to the number of public referrals they issue, as this could explain when it has been hard for me to get.

    Again... I am not here to dispute the behaviour. Just trying to understand if there is a underlaying pattern on this behaviour or no.

    Thank you so much for your opinions.


Comments

  • #2
    Mrs OBumble
    Registered Users Posts: 25,659 ✭✭✭✭Mrs OBumble


    Medical card or not?

    It's not beyond belief that doctors have a target to not refer "too many" people to the public system. But it'd be kept under wraps I'd imagine.

    OTOH, it may be that the GP knows that the better doctors in the field are working in the private system, or that the public system waiting list is crazy. They may not want to tell you why they're not willing to refer you to the public system.


  • #3
    Vorsprung
    Registered Users Posts: 2,814 ✭✭✭Vorsprung


    Mrs OBumble wrote: »
    It's not beyond belief that doctors have a target to not refer "too many" people to the public system. But it'd be kept under wraps I'd imagine./QUOTE]

    I've come across a fair number of conspiracy theories in my life but this is among the best.


  • #4
    Mrs OBumble
    Registered Users Posts: 25,659 ✭✭✭✭Mrs OBumble


    Vorsprung wrote: »
    Mrs OBumble wrote: »
    It's not beyond belief that doctors have a target to not refer "too many" people to the public system. But it'd be kept under wraps I'd imagine./QUOTE]

    I've come across a fair number of conspiracy theories in my life but this is among the best.

    Really?

    Consider the waiting-list management approach used in New Zealand: A GP refers a person for specialist assessment, the person's need is ranked and only those who are bad-enough that they will get treatment within a certain timeframe are accepted onto the waiting list. The rest are referred back to their GP. (ref, in case you're sceptical: https://www.health.govt.nz/our-work/hospitals-and-specialist-care/planned-care-services/questions-and-answers-planned-care-services#1)

    Now I'll bet my bottom dollar that alongside this, the level of non-accepted referrals from GP-practices are monitored, and if it's too high action is taken to educate the GP to stop wasting the hospital and patient's time.


    Whether Ireland has managed to implement anything similar is unknown. But as I said, it's not beyond belief.


  • #5
    L1011
    Moderators, Business & Finance Moderators, Motoring & Transport Moderators, Society & Culture Moderators Posts: 67,523 Mod ✭✭✭✭L1011


    It'd be basically impossible to hide something like that here; with every GP being an independent contractor basically. Someone would go to the media within about, oh, 30 seconds.


  • #6
    Breezer
    Registered Users Posts: 3,228 ✭✭✭Breezer


    If this were the case, I’d imagine we’d have very short waiting lists.

    OP, if your GP is reluctant to refer you to a specialist, it may be that he/she doesn’t feel you need a specialist opinion. The majority of conditions can be managed by GPs. In fact, they can often be managed better, because GPs are more used to looking at the overall picture than many specialists. This is borne out in the fact that countries with more robust primary care get better health outcomes.

    There’s no “incentive” to not refer if it’s necessary, but a GP has a job to do and a reputation to maintain. That job is to use their knowledge and experience to treat patients, not to be a referral letter writing service. I’d argue that a GP who is over eager to refer is a poor GP.

    If you disagree with a decision your GP has made, your first recourse is to discuss it with him/her, and if that doesn’t result in what you deem to be a satisfactory outcome, you can always seek a second opinion from another GP.


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  • #7
    RobFowl
    Moderators, Science, Health & Environment Moderators Posts: 11,667 Mod ✭✭✭✭RobFowl


    Vorsprung wrote: »
    Mrs OBumble wrote: »
    It's not beyond belief that doctors have a target to not refer "too many" people to the public system. But it'd be kept under wraps I'd imagine./QUOTE]

    I've come across a fair number of conspiracy theories in my life but this is among the best.


    TBF GP's in the UK have targets like this and are under pressure not to refer.
    Not the case in this country thank God.


  • #8
    Vorsprung
    Registered Users Posts: 2,814 ✭✭✭Vorsprung


    Mrs OBumble wrote: »
    Whether Ireland has managed to implement anything similar is unknown. But as I said, it's not beyond belief.

    It’s not unknown.

    I’ll grant you that there is one speciality that not infrequently bats away referrals (CAMHS) but you suggest that we are incentivised to avoid making referrals.

    What evidence do you have for this?


  • #9
    larbakium
    Registered Users Posts: 83 ✭✭larbakium


    Breezer wrote: »
    If this were the case, I’d imagine we’d have very short waiting lists.

    OP, if your GP is reluctant to refer you to a specialist, it may be that he/she doesn’t feel you need a specialist opinion. The majority of conditions can be managed by GPs. In fact, they can often be managed better, because GPs are more used to looking at the overall picture than many specialists. This is borne out in the fact that countries with more robust primary care get better health outcomes.

    There’s no “incentive” to not refer if it’s necessary, but a GP has a job to do and a reputation to maintain. That job is to use their knowledge and experience to treat patients, not to be a referral letter writing service. I’d argue that a GP who is over eager to refer is a poor GP.

    If you disagree with a decision your GP has made, your first recourse is to discuss it with him/her, and if that doesn’t result in what you deem to be a satisfactory outcome, you can always seek a second opinion from another GP.

    I agree that this should be discussed between the patient and the GP. The purpose of my post was not directly try to find a response to a scenario I came accross but to discuss if there was something beinr the referral system.

    Where I experienced this, the GP is actually happy to make the referral. Actually they recommended in the first place. But after we undertand that a referral is required, the question is public or private.
    Let's say that there is no time pressure. The patience has some sort of health insurance where going private might not be a bit issue. The patience is happy to wait for the public consultation. The patience is probably going to end up seeing the same consultant/specialist. Just wether the patient goes private or public and often I feel private is the push... hence my question to understand if there was the drive not to push publicly.


  • #10
    Rodin
    Registered Users Posts: 3,130 ✭✭✭Rodin


    Who has decided a scan is necessary?


  • #11
    larbakium
    Registered Users Posts: 83 ✭✭larbakium


    Rodin wrote: »
    Who has decided a scan is necessary?

    Rodin, just realized you never got a reply to your comment. This went into spam. I appreciate its quite old. Having a scan is just one example and eve yourself could feel more comfortable that you would like to get a scan done due to any historical background that could not have been picked up or followed up with an existing GP. The point is not about the decision of having or not the scan but to which route its taking.

    But thank you for taking the time to comment.


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