16 OPINION
16 OPINION
6 OCTOBER 2023 ausdoc . com . au
Insight
GPs in psychiatrist lotto
Anonymous GP , Sydney , NSW .
Why does their referral system work in such a different way ?
MANY of us have been following the debate resulting from the open letter to psychiatrists written by Dr Andrew Leech asking why so many of his referrals are being rejected .
His dismay expressed on the RACGP website is one I share : referrals being rejected for patients at serious risk ; those with unstable ,
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PBS information : Authority Required ( STREAMLINED ). Category : GENERAL - General Schedule ( Code GE ). For verified SARS-CoV-2 infection . Treatment must be initiated within 5 days of symptom onset . Refer to PBS Schedule for full authority information . brittle or difficult-to-treat disorders ; those with unrelenting depression , unstable bipolar disorder , debilitating PTSD or personality disorders ; those at serious risk for potential self-harm .
I do accept there are system issues at play that can be simply attributed as the inevitable but shocking result of inadequate funding for mental health care .
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But for me , there is another question causing deep frustration .
Why do so many psychiatrist referral processes work in a different way to other specialist referrals — to make access more difficult and onerous for patients and GPs alike ?
And why does it often demand what I feel is a serious breach of a vulnerable person ’ s confidentiality ? Obviously , psychiatry referrals
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This might be a history of abuse or trauma , domestic violence , a patient ’ s suicidal thinking or attempts , comorbid substance abuse or misuse , or details of serious dysfunction or disability .
But psychiatrists — at least many of those I deal with — require this information about an unknown patient before they will consider seeing them .
It does feel like a breach of patient confidentiality to provide this kind of information to a doctor they have never seen and who may decline ever to treat them .
An additional annoyance is that this all takes extra time for the GP .
You do the referral . Then you figure out what that particular specialist ’ s referral process is , sending it to the practice for triage , if demanded , before finding out , perhaps days later ( if you are informed at all ), that the specialist refuses to see the patient .
So you send it to another psychiatrist . They will see the patient , but the waitlist is six months long . You try another ; they refuse .
You try another and cross your fingers that you can help keep the patient safe and stable while you keep playing specialist acceptance lotto .
I am not exaggerating here to make a point . This is how it works — and I practise in Sydney , where the numbers and options for psychiatrists in private practice are high .
This process is in stark contrast to any other specialist group , where most referrals can be done and handed to the patient ( while also handing them the responsibility to arrange the appointment ) in one consult ( as it should be ).
I understand there are added layers of complexity with patients needing psychiatric care .
But in general , the referral process should be something you can complete during a single consult and clearly convey to the patient .
Yet this is rarely the case , not least because of the lack of consistency among psychiatrists as to their referral process .
Some require triage of referral ; some will accept regular referrals ; some are impossible to contact .
And as Dr Leech says in his open letter , many never write back to the referring GP .
Like him , I am not trying to complain . I too have many psychiatrist friends and respect them highly .
But I do need to understand how we can work together .