title: Physiological referrals for paediatric musculoskeletal complaints: A costly problem that needs to be addressed.
abstract: OBJECTIVE
  Referrals to paediatric orthopedists for physiologically normal conditions consume limited resources and delay care for patients. The goal of the present study was to formally define such referrals and determine their prevalence.
  
  
  METHODS
  A retrospective review evaluated consecutive referrals to a single tertiary paediatric orthopedic centre over two eight-month periods. Referrals from family physicians and paediatricians were retained for analysis. Physiological referrals were defined as a final orthopedic diagnosis of 'within physiological norms'; and no scheduled follow up.
  
  
  RESULTS
  Physiological conditions represented 22.5% of referrals. The type of referring physician did not determine referral quality. Flat foot, intoeing and genu varum/valgum exhibited physiological referral rates that exceeded 40%.
  
  
  CONCLUSIONS
  Physiological referrals constitute a large portion of the outpatient paediatric orthopedic practice and represent a substantial unnecessary cost to the Canadian medical system. Future strategies to improve referral quality should target undergraduate and postgraduate musculoskeletal education.
authors.affiliation: Division of Orthopaedics, Shriners Hospital for Children, McGill University, Montreal, Quebec.
authors.forename: Alberto
authors.initials: A
authors.lastname: Carli
authors.forename: Neil
authors.initials: N
authors.lastname: Saran
authors.forename: Jan
authors.initials: J
authors.lastname: Kruijt
authors.forename: Norine
authors.initials: N
authors.lastname: Alam
authors.forename: Reggie
authors.initials: R
authors.lastname: Hamdy
keywords: Family medicine; Medical education; Orthopedic surgery; Paediatrics; Public health