Claim A&Es suffer from ‘lazy’ GP referrals

DOCTORS in emergency medicine are concerned GPs may be referring patients to emergency departments (EDs) after charging them for “treatment”, but not always providing it, a leading clinician has warned.

Dr Chris Luke, a consultant in emergency medicine at the Mercy University Hospital (MUH) in Cork city, said one of many factors in ED overcrowding is inappropriate referrals by GPs.

“We see patients more or less daily who are inappropriately referred with long-term ailments which really belong in out-patient clinics or other facilities in the health service. And part of the reason they [GPs] don’t refer them to these facilities is a shortage of such facilities, for example, the shortage of neurologists nationally, but some of these referrals just look lazy,” Dr Luke said.

He added there was a concern that some referrals were on foot of a “perverse financial incentive” where GPs get fully paid to see a patient even if they do not “treat” them but refer them to the ED.

In the last five or 10 years, there had been “a steady rise” in the number of patients being referred with conditions such as long-standing back and joint pain, headaches, and skin complaints, Dr Luke said. “There is a suspicion that we’re being used as a backdoor to out-patient services and investigations, like scans and so forth.”

A small number of GPs “abuse” the EDs of this country, Dr Luke added.

Another contributory factor to ED overcrowding was the “I was passing by, so I thought I’d get it checked out” syndrome, he said.

“That’s another problem for us, people with moles or ingrowing toenails coming to us looking for this and that. It’s been called the ‘McDonaldisation of Medicine’ — people treating EDs as a medical McDonald’s — ‘I’d like an MRI and two nerve tablets to go, please’.”

Dr Luke said the shortage of junior hospital doctors meant there was a constant struggle to keep EDs open. He said he believed the introduction of medical “indenture” — or a mandatory service stint for a few months — might help resolve the problem.

“Irish doctors may have to be obliged to work in emergency medicine, because the mass exodus of our graduates every summer Down Under is a root cause of our inability to properly staff our EDs and this instability is one of the reasons that we were on the brink of closing the Mercy ED, for instance, so often last year.

“I believe we should at least consider such ‘indenture’... Medical indenture is the norm in many parts of the world including Australia, America and Africa, where doctors are obliged to work in unpopular locations for a year or two in return for their training by the state.”