title: Let's get physical! A study of general practitioner's referral letters to general adult psychiatry--are physical examination and investigation results included?
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Parkhead Hospital, Glasgow. denise.culshaw@ggc.scot.nhs.uk
authors.forename: D
authors.initials: D
authors.lastname: Culshaw
authors.forename: R
authors.initials: R
authors.lastname: Clafferty
authors.forename: K
authors.initials: K
authors.lastname: Brown
mesh_terms: D000328:Adult; D015709:Correspondence as Topic; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data; D005194:Family Practice; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D010808:Physical Examination / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011570:Psychiatry; D012017:Referral and Consultation; D012606:Scotland