Anxious parents and time poor GPs are sending children to specialist doctors for constipation, bed wetting, and concerns about how tall or short they are, contributing to long waiting lists for care in public hospitals.
New research has pointed to the trend which coincides with concerns many parents are bypassing GPs to take their children to hospital emergency departments for minor conditions.
A survey of 73 paediatric specialists who work at the Royal Children’s and Monash Children’s, has revealed three quarters thought a referral could have been managed by the referring GP. Waiting times for specialists’ appointments at the hospitals can exceed six months.
Paediatricians from both hospitals told Fairfax Media that these conditions included constipation, which can be treated with laxatives prescribed by a GP, as well as headaches and concerns about height and weight.
They also see developmental queries which a GP should know is still within the spectrum of normality. This includes babies who are not rolling or sitting at six months, toddlers not walking before 14 months, and toddlers not talking before 18 months.
The survey, published in Australian Health Review, also highlighted pressure from parents. It found that 70 per cent of paediatricians felt parents were the main driver of unnecessary referrals “sometimes”, “frequently”, or “almost always”.
Sixty seven per cent said parental pressure also influenced how soon they would follow-up a child to check on them, and one in four said the GP referral letters rarely had sufficient information on the clinical history of the patient. This could lead to a duplication of assessments and expensive tests.
A separate survey of 254 GPs published in Australian Family Physician, found that parental request for a referral to a specialist frequently or almost always influenced their decision to refer. Eight out of 10 GPs said they referred when they did not have experience in the child’s condition or experience with similar patients.
Furthermore, 57 per cent of GPs said it was very important or somewhat important that they did not feel comfortable caring for a child with a chronic and complex condition. One in four said they had insufficient time to manage the child.
Associate Professor Michael Fahey, head of paediatric neurology at Monash Children’s Hospital, said while most GPs were terrific, some referred children to specialists unnecessarily, possibly because they were worried about missing a rare condition or they faced pressure from parents to rule something out.
For example, he said there were many MRI scans done on children to check for brain tumours when they did not have enough symptoms to warrant the scan.
Parents could also be very challenging of doctors caring for their children, Associate Professor Fahey said. Some will do their own research on the internet, read medical journals, and email experts overseas to get second opinions.
“That’s pretty confronting… Caring for these patients should be a team approach. Otherwise, it’s like you’ve been put on Gary Ablett in your first game,” he said.
The lead author of both research projects, Professor Gary Freed from Melbourne University, said unnecessary referrals were likely to be costly because Medicare pays specialists more than GPs. He said there were not enough specialists to handle this growing demand and said the Royal Australian College of GPs should consider designing further education for GPs in paediatrics so more feel confident managing chronic illnesses in children.
But President of the College of GPs, Dr Bastian Seidel, questioned the methodology of the research, saying the survey questions were often too subjective to draw conclusions or trigger a new course in paediatrics for GPs.
Dr Seidel said GPs were exposed to many children’s problems during their training, and that they manage paediatric chronic conditions already, so when they refer to specialists, they usually do so for a “shared care approach”. If a parent has been a main driver of a referral, it does not mean it’s unnecessary, he said.
“Parents want to do the right thing by their children…. A request for a second opinion is often based on it – and it’s appropriate for the GP to engage with the request, and to refer,” he said.