Consultants' complaints about the quality of referrals from primary care physicians: tempest in a teapot?

Objective: To determine whether consultants' general impressions of the quality of referrals from family physicians are consistent with their evaluations of the quality of specific referrals.

Methods: Data were gathered using two questionnaires, completed separately by the same group of consultants working in a Health Maintenance Organization (HMO). Both questionnaires contained the same items and were designed to cover the following topics: (a) the general impression of the consultants about the quality of referrals received from family physicians; (b) their specific evaluation of all consecutive patient referrals by family physicians over a one-week period. Forty consultants employed in an outpatient regional multidisciplinary clinic of the largest HMO in Israel participated in the study. Of the 3136 referrals received over a one-week period, 1466 fulfilled the inclusion criteria, and 1416 were evaluated (response rate, 97%).

Results: Most of the estimates of the number of unnecessary/inappropriate referrals obtained in the general impression questionnaire were 2 to 5 times higher (p < or = 0.001) than those obtained in the consultants' evaluation questionnaire about specific referrals.

Conclusions: This study suggests that consultants' complaints of unjustified and inappropriate referrals from family physicians must be taken with great reservation, at least within the framework of health systems that do not encourage physicians to produce a large number of services.