The GP can recognise, advise, treat or refer patients with any medical or emotional condition. A patient could present with Asthma or Acne, bowel problems or backache, Diabetes or depression, IBS, or High Blood Pressure. You can expect to be helped by a highly competent, knowledgeable and skilled professional.
Procedures such as Iron Infusion are now routinely offered in general practices that have appropriate facilities.
GPs will vary in their ability or willingness to manage issues themselves. Attitude towards diagnostic uncertainty also varies from patient to patient. Most people will understand that there is often a degree of uncertainty in medical practice. General Practice is the most human of activities and outcomes will never be entirely predictable. The GP is guided by guidelines. Nothing stays the same, and guidelines are always changing.
REFERRING TO A SPECIALIST
Let’s look at the main reasons why a GP will refer to a ‘Specialist.’
- For a diagnostic procedure such as endoscopy
- For a therapeutic procedure, or surgery
- For treatment with powerful drugs used in conditions like rheumatoid arthritis, severe psoriasis or severe acne
- The patient is asking for the referral
For long term conditions, many patients routinely ask for an annual referral letter to see a specialist for a condition that would normally be managed in general practice. The GP is there to look after your health needs – but also to provide a service. Therefore, if you ask directly for a referral letter then the GP will likely do just that! To be clear about this, The GP will be sensitive to your anxieties. This is not a problem as long as you realize this is the reason for the referral.
If you are uncertain, or just curious, then simply ask your GP “Do I need to be seeing the specialist again?”
WHICH SPECIALIST SHOULD I SEE?
Most specialities have ‘subspecialities.’ Orthopaedics is the obvious one with upper limb, spinal and lower limb orthopaedics. However, even within these subspecialities there are orthopaedic surgeons who mainly do feet/ankles, or knees/hips, or shoulder/elbow, and some orthopaedic surgeons only do hands. It is not the case that a specialist who only ‘does’ one part of the body is always the best one to see because there may be multiple issues that need to be connected together.
Specialists read their referral letters in advance so that they feel comfortable taking the referral. However, specialists each provide a range of treatment options but not necessarily all treatment options. The GP will have an idea as to which treatment options are appropriate and can match this knowledge with a referral to a specialist who provides those range of treatment options. Often, The GP will do some digging around by asking a colleague or contacting the specialist themselves for advice about the best person to see.
The GP may also get feedback from patients regarding the specialist they were referred to. Whilst the GP can’t take responsibility for everything (not least cost – see below), good feedback or bad feedback (usually attitudinal) will be something that The GP will take into consideration, particularly when such feedback is recurrent.
What is the cost & waiting time for specialists?
The GP does not have access to a list of specialist charges or waiting times. This is an issue because your GP will refer you based on what they do know about the specialist which includes specific skills you may require & professional reputation (often through reading letters back).
It is well known that there are a wide range of fees a specialist may charge for a given service.
If you know that you need to see a specialist for a generic procedure then you may wish to ring around to establish the fees.
This is where larger specialist practices have the upper hand because one phone call to South East dermatology will give you access to 7 Dermatologists, a phone call to Westside Dermatology will give you access to 8 dermatologists, and a phone call to Toowong dermatology will give you access to 5 Dermatologists. Similarly, a phone call to Belmont will give you access to a large number of Psychiatrists. Gastroenterologists may also share the same phone number. Most private surgeons have individual numbers so you’ll need to make a number of phone calls to compare waiting times and prices.
Medicare requires that referral letters go to a named person. The GP would certainly benefit from a live list of prices and live waiting-list times that can be discussed with the patient at the time of making the referral.
One can only hope that a live referral database is developed in future because it would be a huge advance to transparency and consumer choice.
For referral to public hospitals the referral will only be accepted when a number of clinical criteria (often over 10) are met. Even for private referrals, a referral instigated by your GP will need to be for a stated purpose.