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

Abstract

Background/Aim The authors previously conducted a survey of psychiatrists’ attitudes to physical examination and investigations of out-patients. The most common reason for not performing such investigations was the expectation that they had already been undertaken by the general practitioner (GP). We decided to test this theory. Method A series of GP out-patient referral letters to general psychiatry was examined to establish whether findings from physical examination and investigations had been included. Results One hundred and three letters were examined. None of the letters contained information relating to a physical examination. Only one in twenty had information on investigations despite 4 out of 10 patients in the sample presenting to the GP with somatic symptoms. Conclusion 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.