EDITOR, - In their study of the appropriateness of referrals Glyn Jones Elwyn and Nigel CH Stott used the concept of avoidable referrals.1 They found that 38% of the referrals studied over one year had been avoidable, whereas in a larger study Fertig et al found 15.9% of referrals to have been possibly inappropriate when judged against locally determined guidelines.2 Thirty two of the avoidable referrals in the authors' study were considered to have been due to lack of …