The Referral Process and Outpatient System. Second Report: Interviews with General Practitioners

This report is about the referral process and it analyses material recorded in interviews with 45 general practitioners. Data collected from the general medicine clinics and pathology and radiology departments of a district general hospital in south east England were presented in the First Reportl The interviewed doctors had differing patterns of medical practice for certain endocrine diseases which traditionally have been referred to hospital. Variations were also observed in the doctors' clinical judgement when working-up similar cases, particularly in their use of biochemistry work. The pathology data in the First Report confirmed these differing patterns of use. Increased waiting times for barium studies mainly affected the doctors when they suspected a patient of having a malignancy. There were different ways of coping. Some telephoned the consultant radiologists to arrange an urgent appointment while others referred the patient direct to the outpatient clinic. There was, as well, a group of doctors who were routinely substituting barium meals with gastroscopy referrals. The interviewed doctors in general though, did not want open access to the gastroscopy service