A Physio’s guide to preventing medical appointment re-referrals

Musculoskeletal problems are one of the most common reasons why patients see their doctor, accounting for 1 in 5 GP visits (1). According to an Office for National Statistics report, they were responsible for the greatest number of sick days off work in the UK in 2013 alone (2).

Musculoskeletal complaints are injuries or pain in the musculoskeletal system – such as the joints, ligaments, muscles, nerves, tendons, and structures that support the neck and back –  and involve conditions such as tendinitis, low back pain and carpal tunnel syndrome.

Is the current referral system letting both doctors and patients down?

In countries like Australia, medical authorities recognise that the field of musculoskeletal and sports-related injuries is a specialised area of medicine. As a result, a successful patient self-referral system is in place that allows patients to access physiotherapists directly without a formal GP referral (3).

At present this system doesn’t exist in the UK, but hopefully this is something that will change in the near future as medical authorities begin to embrace the idea that most musculoskeletal complaints can be dealt with effectively by a physiotherapist without the need to see a doctor first.

Pilot studies are currently underway to find ways to allow faster access to physiotherapists with the aim of reducing waiting times, improving patient care and speeding up recovery time. One recent NHS pilot study found that physiotherapy self-referrals slashed care costs by 32 per cent and reduced waiting times, while still providing a high standard of care (4).

This makes sense, especially as physiotherapy appointments are longer than your average GP appointment, especially in private practice, making it a lot easier to conduct a thorough health assessment and provide a reliable diagnosis. Appointments with a physiotherapist usually last around 30 to 45 minutes, which is in stark contrast to the average 8-10 minute (sometimes less) consultation you get when you visit your GP.

Poor doctors – who are committed to providing quality, patient-centred care – are struggling to work within the constraints of our current medical system, which involves funding cuts, ever-increasing numbers of patients and short consultation time slots, which makes it frustratingly difficult for them to perform detailed health assessments.

I believe this is one of the main reasons why physiotherapists sometimes find themselves having to refer patients back to their GPs, as health problems can be missed or a person’s symptoms may simply not warrant physiotherapy.

3 common reasons why physiotherapists refer patients back to their GP

To help prevent this from happening to you, it’s important to be aware of common reasons why patients are referred back to their GP:

1. Physiotherapy is not the right option: For instance, a patient with hip osteoarthritis presents with symptoms of severe joint pain, swelling and stiffness, and reduced mobility, which can make everyday tasks like shopping or getting out of the bath near impossible. This can disrupt sleep and even lead to depression. Unless all of this information is relayed to the GP, the doctor may think the person’s arthritis is less severe than it is and believe that physio is the right treatment approach.

According to clinical guidelines, the patient’s condition would be considered too far advanced for physiotherapy to help relieve their symptoms. Instead the patient would probably benefit                  from hip replacement surgery and require referral for X-rays and an appointment with an orthopaedic specialist.

2. Signs of serious pathology: As physiotherapists, we are trained to be on the lookout for red flags that could signal serious health conditions that require more specialist care. These include recurrent fractures or trauma, tumours, unremitting night pain (no relief with bed rest), sudden weight loss (10 pounds or more over a 3 month period), bladder and bowel incontinence, a previous history of cancer and saddle anaesthesia (a loss of sensation restricted to the area of the buttocks, perineum and inner surfaces of the thighs) (5).

Take saddle anaesthesia, along with bowel and bladder disturbances, which are frequently associated with a serious spine-related injury called cauda equina syndrome (6).

3. Incompatible with treatment: Certain health conditions like osteoporosis, osteopenia, pregnancy, advanced diabetes, inflammatory disease and active infection may have precautions or contraindications to exercise and muscle manipulation making physio unsuitable.

How to prevent multiple re-referrals and GP visits

While doctors remain your first point of contact before a referral to see a physiotherapist, providing the correct information on your first visit is crucial. The following tips can make visits to your doctor more productive and help avoid time-consuming re-referrals that delay treatment:

Go prepared: Write down your symptoms, when they started, how long they last, what triggers them and what you think might have caused them to flare up in the first place. Also, highlight any past medical conditions that may be contributing to your current symptoms.

Talk like a doctor: Using specific language that accurately describes your symptoms – like inflammation, trauma, morning stiffness and incontinence – will save your doctor the time of figuring out what you are trying to say.

Honesty is the best policy: Some symptoms can be embarrassing to discuss. However, if you want your doctor to help you quickly and efficiently, it’s crucial to be completely honest. This includes talking about your fears, sleeping problems, substance abuse and sexual problems for instance.

In fact, loss of sexual function (or sensation) can indicate a spinal injury or damage to nerves in the lower lumbar and sacral area, especially if it is accompanied by sharp pains in your lower extremities along with bladder and/or bowel incontinence. This would require immediate medical help and more specialist care.

Here’s to your good health,

Georgios Grigoriou
Senior Physiotherapist
CapitalPhysio

Georgios Grigoriou, Senior Physiotherapist, (BSc)
The Healthier Life, Expert Contributor

Mr. Grigoriou is a Senior Physiotherapist at CapitalPhysio in London, which is considered one of the leading physiotherapy groups in the UK.

Mr. Grigoriou finds it deeply rewarding to help patients recover from injury, as well as helping individuals improve their physical well-being. His experience, in both the UK and Greece, ranges from working in private and public hospitals as well as sports clubs, treating patients suffering from neuro-musculoskeletal conditions, sports injuries, stroke, surgical and cardiothoracics, palliative care and post-operative rehabilitation.

He is currently specialising in managing complex musculoskeletal pathologies as part of his MSc in Physical Therapy in Musculoskeletal Healthcare and Rehabilitation, at University College London.

Mr. Grigoriou is registered with the UK's Health and Care Professions Council, Chartered Society of Physiotherapy and the PanHellenic Physiotherapy Association in Greece.