Medical practitioner's or self referral for an initial out-patient cardiological examination

Background and objective: To compare the clinical characteristics of patients who referred themselves for specialist cardiological examination with those of patients referred by a general practitioner, to assess the usefulness of inserting a general practitioner or general physician before referral, and to project the likely cost effectiveness. Patients and methods: The data on 77 patients referred by a medical practitioner (group 1)were prospectively compared with those of a cohort of 65 patients who referred themselves for specialist cardiological examination (group 2). All patients fulfilling the inclusion criteria had been included consecutively over a period of one year. Excluded were patients with confirmed cardiological disease; those who had previously undergone specialist cardiological examination elsewhere; those who came for a second opinion; and those who had been referred as part of a medical insurance assessment or primarily for invasive tests. Comparisons were made regarding symptoms, investigations performed and the number of new cardiological diagnoses in each group. The assessments of the cardiologists regarding the presence or organic heart disease (before the performance of any diagnostic tests) was tested as to their sensitivity, specificity as well as their positive or negative predictive value. Results: Symptoms and incidence of organic heart disease differed significantly between the two groups. A doctor's referral to a cardiologist seemed to have a greater diagnostic and therapeutic advantage (filtre function). The cost of establishing a diagnosis of organic heart disease for group I patients was on ly about 80 % of that for group 2 patients. A large proportion of group 2 patients did not wish the results to be transmitted to their general practitioner. Conclusions: The relationship between patient and general practitioner needs improvement. Not included in this study were patients with organic heart disease who had not had any access to specialist cardiological investigation or only after a cardiac event.