Family Physicians are an Important Source of Referral:
Networking in Newfoundland

Hassan Khali & Bill Kane

In working with general practitioners (GPs) over the years, we have come to realize that they are an important referral source. In 1966 we decided to research factors influencing GPs' referral decisions to psychologists.

Approximately 417 GPs are working in Newfoundland with about 151 practising in the St. John's area. Through interviews and survey, 48 of these GPs were contacted (as well as 18 out of the 25 psychologists working in part and full-time practice). The survey involved GPs indicating whether or not they had referred patients to private practice psychologists for 29 given problems. It also involved GPs indicating applicable reasons for their having declined to refer to private practice psychologists.

Results indicated that common reasons for physician referral included: seeking help for relationship problems, stress, anxiety, behaviour problems, school problems, low self-confidence, attention deficit disorder, sexual abuse counselling, anger problems, parenting difficulties, and sexual problems. The results of the survey returned by our 18 psychologists were significantly correlated with the data obtained from the GPs, except that psychologists also reported having received a lot of referrals for symptoms of depression, trauma, and sleep problems.

The study also surveyed reasons why GPs would hesitate to refer to private practice psychologists. Reasons reported were that patients were seen as unable to pay for non-publicly funded agencies and/or were hesitant to seek help for mental health problems. The results of the survey of psychologists were again significantly correlated with the data obtained from the GPs, except that psychologists perceived that the GPs were unsure regarding the indication for psychological referral or that GPs were not familiar with a specific psychologist.

Beyond highlighting the nature of referral patterns to Psychologists, this study raised some interesting questions regarding the extent of utilization of psychological services. General estimates seem to suggest that a given GP may see between 30 and 40 patients a day (approximately 600 to 800 patients per month) Of GPs interviewed, 91% reported having had occasion to refer to psychologists. Forty percent of GPs reported having a psychologists with whom they were comfortable referring patients. However, the reported frequency of patients referred in the last year by GPs was a mean of 13 patients (ranging from 1 to 60).

Although we believe that private practice psychologists are still underutilised by GPs, we also believe that the key to GP referral is a close networking relationship. From our experience, those who work closely with psychologists would testify to this. We, too, as practising psychologists should consider GPs as close allies in helping our patients.