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Self referral to physiotherapy and other services would empower patients and doctors

BMJ 2016; 352 doi: (Published 05 January 2016) Cite this as: BMJ 2016;352:h6977
  1. Sara Riggare, Health Informatics Centre, Department of Learning, Informatics, Management, and Ethics, Karolinska Institute, S-171 77 Stockholm, Sweden
  1. sara.riggare{at}

We should make direct access easy when the benefits outweigh the risks

Healthcare systems worldwide face unprecedented challenges over the coming years as populations grow older and sicker. There is only one sustainable solution: more active patients.

Current calls for patients to have direct access to physiotherapists and to other allied health professionals such as radiographers in the NHS, without a referral from a GP, have the potential to lead to improvements for a lot of patients. As a patient with Parkinson’s disease I strongly support the idea of easier access to physiotherapists, because it’s well established that physiotherapy is essential for our wellbeing.1 With the right help we can preserve our stamina, agility, and flexibility for longer despite this progressive disease.

The changing role of the patient

These discussions are part of a bigger conversation, however, about how we should reform our healthcare systems for the future. In this new version of healthcare the role of the patient will be very different, and we have already seen the start of this shift: examples have shown that patients are using the internet more as a source of health information and healthcare professionals—calling for a redefinition of the word “patient.”2 3 4 Of course, as patients take on new roles in which we are more actively engaged in our care, healthcare systems and the roles of doctors will also change. Doctors will have to go from being “experts who care for patients” to being “enablers who support patients to make decisions.”5

This will not mean that doctors will be less important; we will always need their skills and knowledge. It will, however, mean that doctors have time to focus on the patients who need their help the most, because they’ll spend less time seeing patients who are relatively well but who need a referral rubber stamped by the doctor.

Direct access to physiotherapy is one example of self referral that may reduce the burden on the healthcare system without significant risk to patients.

Initiatives to empower individual patients

In Sweden, two initiatives aimed at empowering individual patients are currently being implemented. The first, Patientens Egen Provhantering (“the patient’s own blood test”), enables patients with rheumatoid arthritis who are taking biological drugs to order their own regular blood tests. The patients receive the results directly from the laboratory at the same time as the doctor. The project is run by Stockholm County Council and is built on the national health IT platform to enable scaling up and implementation by other county councils.6

The second example, which is part of an ongoing research study, is in mental healthcare. In some areas of Stockholm, patients known to the ward can admit themselves without a referral if they feel in need of care or treatment.7

What these examples have in common is the empowerment of clinicians and patients. Patients are given the ability to take control and to make decisions relating to their own health and healthcare, and clinicians can use their time more productively.

The most sensible thing would be to make access to self referral as easy and straightforward as possible for patients when the benefits clearly outweigh the risks. It’s also essential that their records enable all healthcare professionals to see the full picture of the support and treatment the patient has received.


Cite this as: BMJ 2016;352:h6977



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