specialist opinion on diagnosis or management eg rheumatoid arthritis
reassurance of patient and/or doctor eg vague chest pain
facilities not available by direct access eg CAT scan, exercise ECG or physiotherapy
patient or relatives' anxiety or pressure for a second opinion eg in somaticising depression
reinforcement of advice in poorly compliant patient
sharing the load of a difficult or demanding patient
deterioration in the patient-doctor relationship so that one party wishes to involve someone else in management
fear of malpractice litigation
individual GP's personality and mood - tolerance of uncertainty, willingness to take risks, personal enthusiasms, perceptions of availability and benefits of treatment
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