[Agreement between specialists' care and family practitioner's intention in patient referral]

The interaction between the general practitioner (GP) and the medical specialist during the referral process was studied in 309 referrals by GPs to medical specialists in eight hospitals in the north of the Netherlands, notably the extent of agreement between the specialist care and the intention of the GP. Furthermore the influence of two factors on the referral process was investigated: 'the clarity of the question in the referral letter' and 'the view of each other's professional tasks'. In most of the cases the GPs allowed the specialists a free hand. In the few cases the GP wanted a restricted consultation the specialist did more than the GP wanted him to do. In one of five referrals the GP or the specialist thought that the specialist had not done what the GP had asked. In most of these cases this impression was not confirmed by the objective evaluation by independent doctors. According to these the referral question was ambiguous. The GP's would like to have more influence on specialist care than the specialists were prepared to allow. The two factors each had an influence on several moments in the referral process. The main conclusion of the study is: the behaviour of the GP does not fit his attitude.