A study of the referral decision in general practice.

The applicability of published models of the referral decision in general practice was investigated by asking general practitioners (GPs) to record data on consultations during which referral to a consultant's outpatient clinic was considered, whether this resulted in referral or not. The GPs were then interviewed about their decisions with particular reference to patient factors, clinical factors, their perception of the risk involved, consultant factors and time factors. The doctors varied in the weight that they gave to the patient's wishes, and also in their selection and interpretation of diagnostic data. Risk to the patient was rarely a major consideration; neither was risk to the doctor's self-esteem. There was virtually no evidence of conflict arising during the decision-making process, and doctors on the whole, did not feel pressed for time. This was, however, a self-selected sample of highly motivated general practitioners. It is suggested that the assumptions on which the conflict model of decision-making is based do not apply to the majority of referral decisions in general practice.