The challenging task of gatekeeping

In this issue of MFP, Ang AT et al looks at the important role of a Family Physician as a gatekeeper.1 The study was conducted in 28 public primary care clinics across four states in Malaysia. They found that out of 100 clinical encounters, there was an average of about 2 referrals (1.76%). It is reassuring to know that most of the referrals were appropriate. The authors have also identified several predictors of referral: complexity of the disease, prior consultations with senior doctors, and availability of the facilities to confirm a diagnosis. However, it is important to note that the study excluded referrals for neonates and from maternal child health clinic. In addition, the appropriateness of the referrals was assessed by Family Medicine Specialists who might have assessment bias.