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Picture this referral

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Dismiss this as the croak of a dribbly, drooly dinosaur if you will. But things aren’t what they used to be.

Especially with referral. I have just tried to refer a lady using our ‘mandatory’ system-embedded two week referral proforma. She’s had a few months of progressive back pain with weight loss, raised CRP, compression of thoracic vertebrae on XR, CXR fine, electrophoresis fine. Bony secondaries until proved otherwise, right, and primary unknown? (Feel free to claim a CPD credit at this point).

So her full work-up has to start somewhere, and I opt for orthopaedics, given the presentation and the X-ray. Can’t do. The only orthopaedics proforma is sarcoma. She doesn’t fit any ‘available’ two week pathway despite clearly needing urgent assessment. A beautifully ironic two weeks of going round in circles later, my loss will be A&E’s gain as, bereft of any better ideas, that’s where the orthopod I spoke to said to send her. Remind me again what we’re supposed to be doing about unnecessary emergency admissions?

It’s almost a relief to hear that there are other maddeningly restrictive referral pathways available

Anyway, it’s almost a relief to hear that there are other maddeningly restrictive referral pathways available. Such as the scheme Up North whereby consultants are insisting on GPs providing photos of ‘query skin cancer’ referrals to help them to decide where to bestow their two week appointments. Obviously an outrageous slur on our clinical skills and another stupid bureaucratic hurdle etc etc. Except, actually, it’s not a bad idea, the only flaw being that GPs are even worse at happy snaps than they are at dermatology.

Then, to cap it all, yesterday I had my first referral request for gender reassignment from a teenage patient and his mother – presented with the assumption that I’d rubber stamp rather than explore the request. Though actually that came as something of a relief. I imagine he wants to become one of those trans people they have these days, and I know when I’m out of my depth. I’m guessing the referral will involve vast amounts of time, box-ticking and swearing, and who knows, a camera.

All I can say is, it wasn’t like this when I was a girl.

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at or follow him on Twitter @doccopperfield