Abstract
The large number of referrals for breast disease necessitates that some form of appointment stratification is carried out to try and ensure that those patients likely to have malignant disease are seen as soon as possible.
A 6-month prospective study was carried out in which all new patient referral letters were assessed and graded on a three-point scale indicating the perceived likelihood of carcinoma.
In all, 496 new patient referrals were assessed and graded. There were 94 classed as 'urgent' (representing a likely carcinoma), 186 as 'soon' (carcinoma unlikely but possible) and 216 as 'routine' (carcinoma very unlikely).
The median waiting times to being seen in the outpatient department after referral were 6, 20 and 32 days, respectively, for the three groups.
Of the patients, 56 (11.3%) were found to have a carcinoma; 41 (73.2%) of these had been placed in the 'urgent' group, 11 (19.6%) in the 'soon' group and 4 (7.1%) in the 'routine' group. All carcinomas in the routine group were coincidental findings.
These results suggest that the information in the general practitioner referral letters may be used to reliably identify most patients with breast cancer, allowing appointment stratification and minimising any psychologically damaging delay before treatment.
Keywords: Breast diseases, Outpatient clinics, Hospitals
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Selected References
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- Curtin J. J., Sampson M. A. Need for open access non-screening mammography in a hospital with a specialist breast clinic service. BMJ. 1992 Feb 29;304(6826):549–551. doi: 10.1136/bmj.304.6826.549. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Dawson C., Armstrong M. W., Michaels J., Faber R. G. Breast disease and the general surgeon. II. Effect of audit on the referral of patients with breast problems. Ann R Coll Surg Engl. 1993 Mar;75(2):83–86. [PMC free article] [PubMed] [Google Scholar]
- Galland R. B., Ross H. B. Sue's breast lump. Br Med J (Clin Res Ed) 1987 May 30;294(6584):1415–1415. doi: 10.1136/bmj.294.6584.1415-b. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hodge J. A., Jacob A., Ford M. J., Munro J. F. Medical clinic referral letters. Do they say what they mean? Do they mean what they say? Scott Med J. 1992 Dec;37(6):179–180. doi: 10.1177/003693309203700606. [DOI] [PubMed] [Google Scholar]
- Howard T. R. General practitioner outpatient referrals. BMJ. 1991 Jul 6;303(6793):59–60. doi: 10.1136/bmj.303.6793.59-c. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lovestone S., Fahy T. Psychological factors in breast cancer. BMJ. 1991 May 25;302(6787):1219–1220. doi: 10.1136/bmj.302.6787.1219. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lydeard S. Improving outpatient visits. Practitioner. 1992 Sep;236(1518):871–875. [PubMed] [Google Scholar]
- Maguire P., Tait A., Brooke M., Thomas C., Sellwood R. Effect of counselling on the psychiatric morbidity associated with mastectomy. Br Med J. 1980 Nov 29;281(6253):1454–1456. doi: 10.1136/bmj.281.6253.1454. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Morris J., Royle G. T. Offering patients a choice of surgery for early breast cancer: a reduction in anxiety and depression in patients and their husbands. Soc Sci Med. 1988;26(6):583–585. doi: 10.1016/0277-9536(88)90021-4. [DOI] [PubMed] [Google Scholar]
- Nunez D. A. Inappropriate out-patient referrals increasing? Br J Clin Pract. 1993 Mar-Apr;47(2):73–75. [PubMed] [Google Scholar]