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One of the thankless, if necessary tasks of the NHS general practitioner is to sort and summarise incoming GP records of patients new to the practice.
While carrying out this noble duty, we looked at the records of an 11 year old patient with cerebral palsy who, in his brief life had seen 15 consultants, one research fellow, one clinical assistant, one senior medical officer, one clinical fellow, one principal health physician, and six registrars on 62 different occasions in 10 different specialties. At one point the patient was under the care of two community paediatricians simultaneously. In an orthopaedic clinic, the patient saw six differently named doctors on six clinic visits. Along with the medical appointments, there were up to seven clinic visits a week for other clinicians: physiotherapists, speech and language therapy, health visitor, psychology, occupational therapy, wheelchair assessment, and other.
This case illustrates a number of important issues for consideration by specialists, who may be tempted to refer:
Dilution of responsibility—vital decisions are made without anyone feeling fully responsible for them; the “collusion of anonymity” described by Balint.1
Increased burden of care on the parents of a disabled child; the sheer physical and time effort required in getting a disabled child to a clinic and then waiting for the specialist can be imagined.
The potential for confusion of opinions between specialists in the same field.
In this case, the lack of any obvious medical benefit from many of the multiple cross-referrals.
We hope that paediatricians will consider carefully the need for cross-referral and the need for a single point of contact for the parent of the disabled child.