Open Letter to South African Private GPs*

Dear South African Private GPs,


I want to tell you today that I am tired.

I’m sure you are tired too, but I want to tell you that, at least in part, you are contributing to my exhaustion – and that of my fellow interns.

I am tired because at least half of the patients that see me in a day at our outpatient clinic, are referred by you.

To clarify: a general practitioner with at least a few years of experience over me, refers their patients to me – an intern with just under sixteen months experience.

Patients without medical aids come to your consulting rooms and you see them, because they pay cold hard cash.

But when you want to do labs or incisions or even imaging, they cannot afford these additional investigations and you give them a hastily-scrawled referral note and send them on their not-so-very-merry way to the nearest state clinic.

I wish you would tell patients before they even pay what the cost will be for additional investigations. I wish you would warn them of the great delay in getting them from your office to mine.

And I so wish you would write proper referral notes.

Do you know that we have a small informal competition going at my hospital? It’s called, WHO GETS THE CRAPPEST REFERRAL LETTERS.

I think I won when I received one reading simply “r/o hepatoma”.

I asked the patients what her GP had told her. She clicked her tongue and said, “He didn’t even take my blood pressure.”

Aren’t you ashamed? Destitute people pay exorbitant prices to see you, because they somehow think that they will get better service than in a state facility (can’t imagine where they got that idea).

Or that other time a  GP’s “referral note” was simply a list of the medications a patient was on.

Or the patient in florid DKA who was sent to us in her own car, without so much as intravenous access.

I get so angry at you sometimes.

But I try to be grown-up, and I realise that you have your own difficulties within the milieu of South African private practice.

I think there are ways it can be made easier for both of us. Maybe you could start by playing open cards with patients right at the door. Maybe you could write a half-decent referral note so that I don’t have to start from scratch.

Maybe we can help each other.



*This is a prologue of sorts to a long diatribe I have planned about what the proposed National Health Insurance could do for primary care in South Africa.


  1. Borderline Med says:

    “r/o hepatoma”? That’s a “thanks for nothing” if I’ve ever heard one. Pisses me off too when that happens. And obviously the patient’s response is “I don’t know”. Sheesh. Sending lots of patience your way.

    PS: I just wrote patients instead of patience. I hastily deleted my mistake :S

    1. barefootmegz says:

      Your postscript made me laugh! Please, don’t send lots of patients! 😛

      1. Borderline Med says:

        Promise I won’t! 😉

  2. As jy dink hulle lees hier maak jy ‘n vet fout. Hulle sit vannaand in hulle luukse huise en drink hulle invoerde wyn wat hulle met my geld gekoop het… nie almal is skuldig maar my bloed kook saam met jou.

    Dankie vir die omgee. ‘n Viriendin gaan haal familie in Potties elke maand en behalwe vir die lang wag, kry hulle alles wat hulle nodig het en vir enkele uitsonderings word hulle met groot respek behandel!

  3. Nancy Ackelson says:


  4. The Elderly Young Adult says:

    This is shocking!

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