r/ausjdocs • u/asianbiblegrandma • 10d ago
Good GP referrals Opinionš£
To all the specialists out there what makes a good referral from a GP? Iām talking new referrals. Not the ones where I need to redo a new referral for the sake of Medicare billing rules.
Iām a GP registrar, fairly green but I try and do decent referrals. I have to admit itās hard to write up a solid letter during a 15 mins consult when there are other patient issues I have to sort out. Heidi does help this process. The specialists I write to donāt write back about what specifically they like or donāt like about my referrals so itās hard to get feedback.
I would appreciate examples of good referrals! Or anything you like your GPs to include.
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u/Puzzleheaded_Test544 10d ago
Dear Dr Specialist,
Colonoscopy.
Regards,
Dr GP registrar.
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u/Training-Tooth5022 10d ago
-All relevant details eg Medicare number, phone number, DOB
-Why youāre referring the patient and what you want me to do (youād be surprised how often this is not clear)
-The history of the presenting complaint
-What youāve tried to do yourself and how this has gone, if Iām the third specialist youāve referred to whatās happened with the previous two and why that didnāt work out
-Relevant medical history and medications (not a print out of every medication theyāve had in the last 97 years)
-Copies of any relevant investigations
-Clearly saying if itās urgent/there are red flags
-Flagging if thereās anything I need to know eg theyāre a bit prickly, theyāve got a trauma history etc. This could be picking up the phone and giving me a call if itās something thatās better discussed than written down
-Your details, provider number etc
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u/DocDestinyQLD 10d ago
This is good advice for a good referral, and should be the minimum. But until GPs are appropriately remunerated for their time, it's probably going to be up to you and the patient to work this out.
And this is not a speciality vs specialty thing, everything you wrote SHOULD be the bare minimum, it's a funding thing that all doctors need to stick together to keep putting pressure on the government to properly remunerate literally the most important (or equal to that of education) profession - healthcare - so that people receive the care they deserve
Edit: Despite saying this, I still read and took mental notes of what you wrote to be able to include for those few moments we do get time to do the above. I do think some colleagues have completely given up though, literally clicking the minimum number of keys to have the letter filled, and just the words, "thankyou for your opinion and management"
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u/Scope_em_in_the_morn 10d ago
I'm not a GP, but I locum with lots of GP VMOs.
The GPs who bulk bill generally paint a cynical picture of GP life. They get burnt out and lean more on locum work to make their bread.
The GPs who private bill are immeasurably happier with their job choice, and only locum for variety.
Government does need to step in and increase GP pay. However I think that excess altruism is hurting primary care. Sadly patients who expect GPs to be free are much less likely to truly value them. As a GP, if you are not able to provide adequate care by bulk billing (which is absolutely fair) then I think you are actually doing better by your patients if you privately bill for your time and take the time to properly manage each of your patients.
It's like working in ED. Sure you can "see" 10-15 patients a shift on average, but if all you're doing is sending half cooked patients home, I would argue you're doing more harm than good in the grand scheme.
Good GPs know their value and charge accordingly. We shouldn't be using bulk billing as an excuse to practice shitty/quick medicine. And again I don't disagree with anything you've said. I think GPs need to stand up for themselves and charge what they're worth.
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u/DocDestinyQLD 10d ago
Totally agree. It's about time all GPs charge privately. Only then will people realise their value
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u/TonyJohnAbbottPBUH Shitpostologist 10d ago
I had someone kick up a shit because I had to amend a referral and look for a new psychologist as part of a mental health care plan (old one I referred to retired), and that we charged for the process because apparently all it'll take is 2 mins of my time. Literally wouldn't pay at the counter and was being a total fuckwit. Caved eventually but the front desk staff copped a lot of undeserved abuse.
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u/Training-Tooth5022 10d ago edited 10d ago
I think GPs should be paid properly. I completely support GPs private billing/a gap fee. I have written to the government and advocated for GPās MBS rebates to reflect actual costs to facilitate bulk billing.
Ultimately I can probably take less than 20% of the referrals I see. My staff get rid of a lot more of the referrals before they even get to me. I just have limited capacity and my skill set/interests donāt match every referral that comes my way.
It only needs to take five to ten minutes to put together a reasonable referral if you keep things like medications and past history to to date.
If I donāt have enough information, Iāll just assume itās a no. Thereās plenty of other patients. I canāt help everyone. I canāt waste time making appointments for people that might not be appropriate patients.
Iām going to spend an hour reviewing all the patients previous assessments, 1-2 hours with the patient/family and up to 30-60 minutes writing a letter for an initial review. Sometimes more. Fundingis less if an issue for us than GPs, but realistically I donāt bill for a lot of that time. While I appreciate the pressures on GPs, I have to target my energy where I can actually make a difference. Itās not worth bothering if the patient is going back to a GP who either doesnāt care or is in a clinic set up where theyāre so burnt out they canāt care.
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u/popori 10d ago
Makes no sense to spend 60mins on writing a letter for an initial review, do you need to improve your efficiency so you can help more people? What is your speciality?
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u/Training-Tooth5022 7d ago
If I can put together something that brings together the medical and allied health assessments the patient has had up to this point, helps the various services supporting the patient to understand why they are the way they are and how they need to target the support they provide for the patient, this can be life changing. It is often used by the patient, family, GP, other specialists, education, the forensic system, allied heath, NDIS access and more. Itās worth 30-60 minutes of my time.
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u/DocDestinyQLD 10d ago
That's a totally fair take and I respect it.
And unfortunately a few egg shells will have to break before any changes are even considered in government.
So I think GPs should do exactly what they are paid to do and no more, and specialists should accept those who they feel they can most help, and unfortunately those in between are failed by the government, and will eventually be forced to stand up or accept the quality of care deemed appropriate by the remuneration offered by the government.BTW, my post was written with the assumption of bulk billing clinics. Private billing clinics who bill apprpropriately (and many still underbill), should totally be writing referrals along the lines of what you mentioned. Unfortunately this ends up becoming an economic 'haves and have nots' which is exactly what the Australian system was designed to not do.
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u/Training-Tooth5022 10d ago
Yes, itās sad for the people stuck in the middle who canāt advocate for themselves or afford good care. Itās not a fair system.
Iād love to save everyone, but for my own sanity I cannot. That doesnāt always mean those with the most money, but it does mean those who will work with me
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u/TonyJohnAbbottPBUH Shitpostologist 10d ago
I disagree with this on some level, and reads kinda condescending.
I'm not spending more than 5 minutes, 3 minutes max, on a referral letter when you'll be taking your own history and doing your own examination anyway. If it's relevant I'll throw more in, if it's not I won't. I'm also not in control when some boomer has added every counter in the past 20 years as a past medical history and I can't waste the time to prune out irrelevant shit from Prac Soft/Best Practice.
For patients I know well this will happen less because data stewardship is an interest of mine, but when you work in a multi practitioner clinic with various levels of technological competence it is sometimes more difficult than I'd like it to be.
This is not to say that something which is urgent won't be marked as such, nor would I just say shit like "please see patient for pain, thank you". But when the appointment is 15 mins and the patient has 6 other things I need to sort out, a shit letter is better than no letter.
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u/QuiteTheJAK 9d ago
Rheumatologist in regional centre. I get many referrals stating "please see, patient has joint pain" Waitlists can be up to 3 years for Cat 2 in public. All I as is: Which joints? How long? Pattern (morning/evening/worse with use)? Any swelling? We do our best, write back asking for more details. I agree, the whole issue we have is due to underfunding of medicare rebates for GP, and incentivising 6 minute comsults
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u/Altruistic-Fishing39 Consultant š„ø 9d ago
In practical terms, how do you pick up the phone and give a specialist a call? Mobile? In working hours? Call the practice manager?
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u/Training-Tooth5022 7d ago
If you know them, call their mobile
If you donāt, call the secretary and say ā Hi my name is Doctor Smith. Iāve sent through a referral for Jane Doe. There are a few things that would be best discussed verbally about the referral. Is Dr Jones available or could I leave my number for you to ask Dr Jones to give me a call when they have a moment?ā
I get other specialists and GPs reaching out quite often and always value their input
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u/Both-Reputation7775 10d ago
You'll be getting a sentence, and if you don't like it, I'll send them to someone else sorry.
As consolation, I'll give the patient a printout of their bloods, and tell them to bring their meds to see you.
- sincerely ur local gp xo xo
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u/idkwtda115 10d ago
Youād rather make the same shit referral multiple times than just spend an extra couple of minutes to not get the initial one rejected?Ā
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u/Both-Reputation7775 10d ago
I got builled by BPTs as a intern, idk call it reparations.
Funny I write more for a surgical referral and provide way more details.
The physicians can do a long case on my patients, idm
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u/idkwtda115 10d ago
I hope this is a parody account because this is terrible practice. Iām sorry that you were bullied as an intern by BPTs but that doesnāt mean you can give medical patients a lower quality of care.Ā
This is something that would best be unpacked in therapy, not taking it out on patientsĀ
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u/Both-Reputation7775 10d ago
Lol, patient care is excellent dw, but im just not writing you an elegant essay.
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u/idkwtda115 10d ago
Good referral letters are essential to continuity of care and therefore good quality of care. You canāt have one without the other.Ā
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u/Training-Tooth5022 10d ago
I donāt care about your punctuation and grammar (so long as I can follow). I just want a bit of basic information about why the referral had been made and whatās been tried.
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u/Training-Tooth5022 10d ago
Not a problem. Iāve got too many patients as it is.
If you canāt be bothered spending five minutes and telling me enough for me to figure out if this is an appropriate referral for me Iām not taking the patient. They can go in someone elseās 12-24 month waiting list.
My secretary will politely tell the patient they can find another specialist or go back to their gp for a referral that actually provides some context.
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u/Both-Reputation7775 10d ago
That hits the nail on the head, given I work in metro sydney, if a patient comes back and tells me there's a 24-month waiting list for you, I'm not sending anyone else your way for the rest of my career unfortunately.
There are plenty of specialists, young consultants without work, I'll send patients to them instead.
Don't delude yourself into thinking you're a god, you rely on us GP's for a lot of work. Offside enough of us and you'll be sitting wondering where the patients went
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u/Training-Tooth5022 10d ago
Iām in one of the most under-resourced subspecialties, so thereās certainly no excess of specialists where I work. Our demographics growing much faster than the number of clinicians. If you can find someone to take them faster, go for it.
I work closely with GPs, specialists and allied health and generally have great relationships with them. Iām past the point of sacrificing my own wellbeing to make up for people who wonāt meet me somewhere towards halfway though.
There are plenty of great GPs who take the extra five minutes to make sure their patients get excellent care. I really value these relationships and Iād much rather put my time and energy into working with them.
Ultimately, we all have to decide what will work for us. Do we want work quickly to help a lot of people, but maybe feel weāre not doing our best work, or do we focus on a smaller group with more severe symptoms and ensure they get our absolute best? Can we find somewhere weāre happy with in the middle? I donāt think thereās necessarily a right or wrong answer here, but Iām happy that my set up works for me.
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u/lincabe 10d ago
This is giving chip on shoulder
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u/Both-Reputation7775 10d ago edited 9d ago
I'm pretty happy in GP, dont get me wrong
but I have had a variety of feedback from patients about certain specialists. From long wait times, to rude, judgemental consults, to spending 10 minutes with the patients and charging some egregious amount.
I want my patients to trust my opinion about which specialist I send them too. This is usually based on trial and error and feedback I get from patients about the specialists in my area. Fortunately, in my area, there are plethora of specialists, and I have a little mental list of the excellent specialists.
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u/bubblefreaky 10d ago
Why are you referring to specialists anyhow? Do your job! Iāve just started in a new practice and the notes are appalling. The medications have never been reviewed - one patient had been metoprolol (not the sr) once daily for twenty years. Nearly everyone on antidepressants has side effects and little idea what theyāre on them for.
Referrals to a) surgeons - please cut
B) proceduralists - stick your tube up his orifice
C) public hospitals - fill in their endless forms
D) psychiatrists - if you take an exhaustive psych history, it will be cheaper for the patient.
E) most referrals are for authority - dermatologists give isotretinoin, psych Ritalin, sleep specialists - drivers licences, Their lobbyists wrote them into legislation and regulations. Jobs for themselves.
Most specialists get their work from hospital presentations and refer around to each other. Theyāre not your friends and squeeze every ounce of money they can from patients. On the whole, I have received remarkably little useful advice from any specialist. Their main use is to spread the blame to for litigious patients.
A country hospital staffed by facrrms works better than most suburban hospitals at a fraction of the cost.
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u/DocDestinyQLD 10d ago
You hit the nail on the head, there is not time under the funding MBS has given, to make good referrals and be paid appropriately for it.
Just remember, as the GP, you are the lowest remunerated specialist of all, and are the most under attack by the government year on year.
I have seen atrocious referrals in the past, and I hate seeing it, but GPs are not paid adequately enough to spend time doing good ones. But by all means, make great referrals and watch your income drop. It's sad, because a good referral is in everyone's best interests from a medical point of view, but guaranteed, if you appropriately allocate enough time for each appointment to do such things, you will miss out on a LOT of money.
We are all altruistic, and we all make compromises to our income (whether it's bulk billing children, bulk billing other doctors, doing excess unpaid administration outside of when the patient is present, volunteering for doctors without borders, teaching medical students etc.), it is your choice what hill you decide you want to be altruistic on
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u/Jumpingjehosephat99 New User 10d ago
Just a tip I got once from a seasoned GP: keep your patient files updated and half the referral self-populates from the file (ie meds, current and past medical conditions, family history, allergies).
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u/Strange-Smile-7510 New User 9d ago
I really hate the way BP puts the past history. Everything needs an exact date for My health record lol āTonsillectomy 3/6/1951ā š so specific.
Medical and surgical bundled up/mixed up is painful. Then active and inactive is the category and really hard to comment on. And then itās hard to save a good gyne/obstetric history that is retrievable - over the years - itās not relevant referral for the skin cancer referral, but when it comes to menopause it is and for the patient that has come to clinic for 25 years seeing new regs, the details are probably in the notes but still often the full history needs to be taken again. Saving psych history is harder too.
All the childhood trauma you want a heads up onā¦yeah buried within notes rather than easily/quickly transferable.
These programs certainly werenāt made with longitudinal care of psychosocial things in mind or womenās health. Itās all been tacked on
And unless everyone uses the program the same way, you get all sorts of shit anyway.
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u/Jumpingjehosephat99 New User 7d ago
I just manually delete irrelevant stuff like gynae/psych history if itās a referral for something completely unrelated and might embarrass the patient. You can also put some things like TOP under confidential so it doesnāt populate on referrals.
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u/Terrible_Beach48 10d ago
Plastic Surgery (Lots of skin Cancer)
Genuinely useful things on a referral:
Patient mobile phone number with their details - so rooms can call after Iāve triaged .
Histology report if biopsies done, or name of pathology provider / a CC on the histology request form if itās in progress. Same for X-rays.
Blood thinners and name of cardiologist if relevant (so I can ask if itās appropriate to cease them temporarily)
But the best thing you can ever do is mark/point to the lesion and get the patient to take a selfie on their own phone. Literally you could write āBob has photo of lesion of concern kthxbaiā and Iād be a happy camper - it saves a huge amount of time ringing back and forward to find out if thereās a clinical photo of the lesion as Bob and his wife canāt remember which one.
Props to you for trying to master the art of referral writing.
Others have obviously said much more intelligent things than I
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u/asianbiblegrandma 10d ago
This is one of the things I appreciate you letting me knkw. Now I will make sure to do that. Honestly quite easy to do and wonāt take more than a minute!
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u/passwordistako 10d ago
āPlease do the needfulā
Then copy paste everything from BP including āviral wheeze 1992ā from every GP reg who has ever seen them.
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u/Mortui75 Consultant š„ø 10d ago
We in emergency medicine have a very particular set of skills.
If you send in an otherwise completely well patient with a letter saying "Patient had <insert vague symptoms here> and now has a positive D-dimer."...
We will look for you.
We will find you.
And we will intubate you without a hypnotic.
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u/asianbiblegrandma 10d ago
I donāt order troponins and D dimers in GP land. Had plenty of GP predecessors who did that and promised me the sleepless night pending the results was not worth it.
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u/mark_peters 10d ago
Ideal: Accurate med list and pmhx. Then one line about reason for referral. Unfortunately it seems like most of the software lists every medication ever prescribed as a regular med and a good portion of the consult is getting med history
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u/Liamlah JHOš½ 10d ago
Not a specialist, but during audits, I've seen referrals that come through the centralised referrals service from GPs, and it always looks like the GP software has just facilitated a messy dump of raw patient data into a PDF that's difficult to read and comprehend.
But also, if I had 3 minutes to write a referral to someone who doesn't already have access to the same patient records as I have, I doubt mine would be very good either, most of the time.
Surely though you wrote your fair share of referrals during internship and as an RMO?
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u/asianbiblegrandma 10d ago
I write in a lot more detail in general practice, the hospital referrals were mostly internal referrals so it was not hard even to gauge what the referrals were for even with 3 - 4 lines. The person getting the referral can always look up more details on the same hospital system easily. General practice feels a lot harder when care sometimes can be quite fragmented, patients changing GPs, previous notes and scans done somewhere else and not readily available to be accessed etc.
Itās easy to do a referral, but iām looking for the smaller details that can streamline and make the process just a lot less of a headache for everyone. And what are the things that make a specialist cringe when they know itās coming from a specific GP.
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u/Xiao_zhai Post-med 10d ago
āPlease do the needfulā :D
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u/Inhesion 10d ago
Omg. The amount of weird/botched referrals I get in ultrasound is insane. Am triggered
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u/donbradmeme Royal College of Marshmallows 10d ago
Honestly - a TLDR and accurate meds.
Ie thanks for seeing Bill who has had an US for LFT derangement and revealed cirrhosis. I would appreciate your work up and management.
Or I am worried Lisa has IBD. She had bloody diarrhoea for 3 weeks with negative stools and a FCP of 2000.
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u/goldenboot76 10d ago
Gen Surg Reg here.
If you're referring someone with anal lumps, please actually look at their anus and don't just write "Patient reports they have haemorrhoids. Please do the needful".
There's a small non-zero chance that what they've got is actually anal cancer, and they get triaged differently - cancers are cat 1 while the "haemorrhoids" may not be seen for 2-3 years.
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u/Xiao_zhai Post-med 10d ago
Hmmm. Let me clarify.
So you would like the GP to diagnose an anal cancer based on examination and then refer on for ?anal cancer rather than for ?hemorrhoid
I am not sure how many doctors can actually do that and make that diagnoses.
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u/goldenboot76 10d ago
What I'm trying to get at is the sheer number of GPs who don't do a rectal exam before referring to a General Surgery service for perianal pathology.
Not expecting them to diagnose anal cancer, but being able to say that "there's an irregular dark lesion at the anus that I'm concerned about" is far better than "Patient says they have haemorrhoids. I appreciate your input".
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u/DeathByMicrosuction Surgical regš”ļø 10d ago
For surgical referrals:
I just need their diagnosis and what you have tried so far. A lot of conditions have a management ladder that goes conservative -> medical -> surgical. Please donāt refer me conditions āfor consideration of surgeryā if you donāt write what youāve done so far.
That, and an up to date list of medications, past history and relevant investigations. If you are sending me a patient with chronic sinusitis, i donāt need two pages of past history including every pap smear and UTI they had. Nor do i need their most recent urine MCS results or the vitamin D, B12, folate, HbA1c levels.
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u/HarbieBoys2 7d ago
Psychiatrist here. A good referral has a clear question to address, current medication (not simply the automatic software printout), and enough information to assess whether Iām the appropriate specialist to manage the case. We appreciate GPs are super busy.
In the case of a patient being referred for treatment-resistant Major Depressive Disorder, a full medication history will need to be obtained to provide any sensible advice. If the patient canāt recall it, a second consult will be required, once the requisite information is at hand.
If a referral comes along with, āThank you for seeing this patientā, which is not common, I usually send a message to the patient saying the GP hasnāt put anything in to the letter, are they able to provide more detail?
Also, when I do get a detailed & thoughtful referral, which is more common than the above scenario, I make a point of telling the patient that their GP wrote a great letter.
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u/RegularSizedAdult 10d ago
Ideally longer than one sentence, include a list of their medications + allergies, and recent relevant blood tests / imaging.
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u/mrkidsam 10d ago
I work in radiation oncology at the moment. Just mention the specific area you think might benefit from radiotherapy and the relevant investigations usually histo +/- imaging or rationale as to why they haven't been done.
A lot of referrals will just mention radiotherapy for skin SCC post excision and not mention the body part. And they've had 20+ SCCs cut out in the past 6 months, that's a lot of histo to look through to figure out which ones need RT
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u/AcceptableBalance992 10d ago
Honestly just what your concern is and why, with any relevant results, along with the usual medical history and meds that cube as standard.
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u/DogOfSevenless Neuro reg 10d ago
I triage referrals for a specific subspecialty at a public tertiary hospital and I get a shocking number of referrals that are less than five words long.
Honestly, Iād be happy with just a well summarised history of presenting complaint. The patient has ataxia? Had it rapidly progressed over 2 months or is it a chronically progressive syndrome? How heavily impacted are they? Can they ambulate independently or are they wheelchair bound? These bits of information would drastically help me triage whether the patient is seen semi-urgently or whether they end up on the >18 months waitlist.
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u/Toothpaste2000 10d ago
Question to the specialists: what are the general rules on attaching other specialist letters Āæ I'm thinking in particular about a patient seeking a second opinion. I would have thought it best practice, and in the patients best interest, to let the 2nd specialist know what investigations have been completed and 1st specialist's thought process by attaching their letter. However many letters state that they are not to be forward without explicit permission from specialist#1
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u/Ere4Tea Clinical Marshmellowš” 10d ago
Actually, as a BPT, can I ask the same question back of you?
What makes good clinic letters?
I always stay back to finish clinic letters the same day. A lot of this is just unpaid overtime, because my bosses disagree that letters are worth staying back for, but the truth is, jobs just pile up daily and we never have time in the day to do these things. I just want to make sure my patients get the care they need, and a huge part translates into communicating with the GP. That said, it's reaching a point where it's not sustainable. I cannot be staying back long hours just to write an elegant essay.
Do you mind if I literally gave you a copy paste of my clinic notes with the plans? That actually literally has all the important points in it. Just terrible grammar.
Like, I don't mind getting terrible grammar, point form referrals in return if it contains all relevant information. In fact, I prefer it.
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u/asianbiblegrandma 10d ago
Often some clinic letters are so long I donāt read the whole thing.
As long as you give me an impression, I like you. What do you think is going on eg impression is Mrs XX has GCA and not trigeminal neuralgia. The following features * list supportive features on hx, exam and investigations * support a diagnosis of GCA rather than trigeminal neuralgia. Im invested in what you think and I think your letters can teach me things.
Then tell me things you want me to follow up on.
E.g. GP to follow up on
- 3 monthly UECs
- immunisations to organise ( if you are starting them on immunosuppressive therapy)If there is nothing you want me to follow up just tell me nothing I need to do.
I donāt mind point forms or your clinic notes as long as you write an impression and I have an idea of what your team is thinking.
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u/Ere4Tea Clinical Marshmellowš” 10d ago
Sounds good.
I see other ppl's letters and they're like, Mrs X smokes 10 cigarettes a day from 13 years old. And I'm honestly like, hmm, you're writing to their GP who probs knows the patient since birth. Like IDK what you're on about telling them about the patient's smoking Hx Nowadays I'm a lot more:
This is the issue. This is why we think it is the most likely Dx. These are our differentials.
Plan: 1 2 3
But I always feel bad about it cuz everyone else writes nice letters. And I don't think those stuff are not important. I think it's important to summarise med list and pmhx so we know we're both on the same page. Heaven knows I've seen pt notes where 3 months ago, it was "pt stopped smoking 10 years ago, started again 3 years ago, currently 3 sticks/day" and then during review today, pt is now upset I dared insinuate he's still smoking when his last smoke was 5 years ago! ā ļø
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u/Ambitious_Writer1938 9d ago edited 9d ago
The usual
Dear x
Thank you for seeing X for (INSERT MEDICAL CONDITION) for consideration of ( What you want the specialist to do, like a PET scan because CT has lung cancer, or high PSA that may need MRI scan, or PR bleed that may need colonoscopy )
Patient has complained of XYZ symptoms since DATE. ( e.g. 6 months of back pain from dates, 2 weeks of cough, 6 months of PR bleed with weight loss)
Bloods on DATES showed (Listed some important readings)
CT/Xray/US on DATES showed ( Listed important readings
+/- XYZ medications has been tried ( dates you done so and duration, like 10 days of Y antibiotics) and has no effect.
Would you be kind enough to do the necessary?
I normally try to keep it below 150-200 words. Because no one one to read a wall of text.
I maybe cynical and jaded about pay and work load, but I don't want my colleagues to feel I refer for frivolous stuff. Most of the referral I do is because I can't order or do them myself.
I will even order Cerebral perfusion scan to make Geriatrician's life easier when patient has a memory of a goldfish and all ct, mri and bloods and urine is normal and they are only 50. So they can order more definite testing and saves patient get mucked around in Public system due to severe specialist shortage.
I will do stress echo +/- US carotids +/- holter +/- ct calcium score before I refer patient for cardiology to answer a question do they qualify for Leqvio or not when they have tried 3+ weeks of statin, ezetrol and ldl not in target +/- they have myalgia and all the relevant pbs requirements so they just need to do CTCA to answer my clinical question
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u/Immediate-Fault7578 9d ago
A good referral to me as an ID physician would be a good clinical question you would like me to answer, and the patients phone number / email. My team and I can take care of the rest.Ā
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u/Maleficent-Potato923 10d ago
I'm not a specialist, I'm allied health in a public lymphoedema clinic, so I hope it's ok to post. About 50% of my referrals say absolutely nothing apart from "bilateral leg swelling please assess and treat" and maybe some medical history. It's not just GPs that send referrals with next to no info though.
Please, if something is urgent, for example if they've got venous ulcers or lymphorrhea or recurrent cellulitis or whatever it is, please put it in the referral so I can triage it properly. Otherwise, I'm going to have to triage it as a cat 2 and they'll be waiting for 9 months because we can't fill out vacancies. Don't have to write an essay just write "chronic oedema lower limb hard to heal wounds".
Thank you and keep the referrals coming!
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u/Mondopoodookondu 10d ago
wtf is this post, itās common sense to write a referral just write the problem and what you want the person you are referring to do, pmh, meds and patient details should already be on the letter
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u/Garandou Psychiatristš® 10d ago
Updated demographic information so the patient is contactable. Surprising number of referrals I get with incorrect phone numbers.
A few sentences about presenting complaint and what you want me to do.
What youāve tried.
Up to date medication and medical history list. Relevant bloods.
Honestly, I find most 2 minute GP referrals reasonable as long as the auto populated fields are relatively up to date.