Why we need a referral system in healthcare

The healthcare system in Bangladesh is plagued with so many problems that some fundamental issues are often overlooked. The absence of a strong referral system in healthcare is one of such issues, which has created a series of problems affecting patients, doctors, and the overall efficiency of the health sector.

In most countries, particularly those with well-organised healthcare systems, have a strong referral mechanism in which patients first consult general practitioners or GPs in their community - be it rural or urban areas. The GPs assess their conditions, offer primary treatment, and refer them to appropriate specialists, if necessary. This referral system ensures that patients receive the right treatment at the right time and reduces unnecessary expenses. Bangladesh should have such a system in place as a former colony of Britain, a good example of a well-organised GP-driven referral system that directs patients to start with primary care, because the foundation of Bangladesh's healthcare system was established during British rule. However, the present scenario in Bangladesh is far away from that system. Patients here usually bypass GPs, heading straight to specialist doctors of their choice due to the absence of the referral system. Most of the patients believe that specialists will solve their problems more effectively, no matter whether their condition actually requires consulting such specialists. This approach leads patients to misjudging their conditions and ending up visiting the wrong type of specialist. For example, someone with a common skin rash may rush to a highly reputed dermatologist without realising that a GP could have diagnosed and treated the issue in a fraction of the time.

This approach often causes an unnecessary burden of expenditure on patients, who have to meet a major portion of the medical expenses from their own pocket unlike the citizens of most countries. According to a World Bank report, Bangladesh's out-of-pocket expenditure on health per capita at purchasing power parity was the 8th highest among 45 least developed countries in 2021.

Specialist consultations, diagnostic tests, and treatments, which can sometimes be avoided with the guidance of GPs, generally involve higher fees compared to primary care services.

Choosing specialist doctors first also creates a huge burden of patients on "celebrity doctors", who are nationwide recognised for their expertise in particular fields. The excessive concentration of patients on a small group of doctors limits access for those who genuinely need their expertise. These doctors face overwhelming patient queues, making it difficult for them to spare adequate time for each case. Patients have to wait for hours, sometimes days, to secure an appointment, only to find that their issue does not require such specialised care. Such wastage of time sometimes heightens the risk for those encountering life-threatening conditions.

The absence of a referral system also leads to an inefficient use of medical resources. Without the system, specialist doctors spend a significant amount of time handling cases that could easily be managed at the primary care level. This inefficiency lowers the quality of care and delays in specialist treatment for serious conditions can have critical consequences.

The health scenario in Bangladesh would be changed drastically if the country is able to establish a well-designed referral system. Developing such a system would be hard, but not impossible. The existing network of community clinics and upazila health complexes could serve as the foundation for this system. But for that these facilities would have to be equipped with qualified doctors trained in general practice, along with sufficient medical supplies and diagnostic tools to handle common ailments. Besides, a campaign would also be necessary to make people understand that consulting a GP first is not a compromise in care but a smart, efficient step toward proper treatment.

rahmansrdk@gmail.com