Let's Get Physical! A Study of General Practitioner's Referral Letters to General Adult Psychiatry — Are Physical Examination and Investigation Results Included?

Abstract

Details of physical examination and blood tests are not routinely included in referral letters to general psychiatry. This may lead to missed diagnoses of primary or secondary physical illness in psychiatric presentations. Unless it is clearly stated in the GP referral letter, it is unwise to assume that necessary investigations to exclude physical causes of presenting symptoms have been performed. Suggestions are made to improve communication between GPs and psychiatrists.

WPA guidance on how to combat stigmatization of psychiatry and psychiatrists

“…Some authors suggest that there is a “lack of respect among the medical community” 120, which stereotypes psychiatrists as “unsure, ineffective, useless and incomprehensible” 244. This perception of psychiatrists as “not real doctors” is also reflected in the fact that referral letters from family physicians to psychiatrists rarely contain information about physical symptoms 255. Nevertheless, medical doctors acknowledge that psychiatrists can help people with mental disorders and possess relevant expertise 256.…”

EPA guidance on how to improve the image of psychiatry and of the psychiatrist

“…Inevitably, this stereotype leads to further discrimination as well as marginalisation. Thus a lack of respect towards psychiatrists can feed into further prejudice and it has been shown that letters of referral to psychiatrists often do not contain detailed information about the physical state of the patient [36], indicating that there may be a perception either that the physical condition is not important or relevant to the psychiatric state of the patient's well-being, or that psychiatrists do not need to know or will not be able to deal with physical issues. In addition, this may be perceived as a lack of awareness of the physical condition.…”

Improving quality of referral letters from primary to secondary care: a literature review and discussion paper

“…Previous studies of referral letters have found content deficits in the documentation of: medications (Toleman and Barras, 2007); prior investigations (Culshaw et al ., 2008); presenting symptoms (Su et al ., 2013); and appropriateness, particularly regarding stated level of urgency (Blundell et al ., 2010). One study reported that completeness of documentation could have an important impact on how and when the patient is managed by specialists (Jiwa et al ., 2002).…”