Patient referrals should be reviewed. All the evidence shows that 40% of the time, when a GP decides that referral is the next best step in the patients care they are wrong. Those wrong decisions cost patients time, money and worry. But GPs should not be excoriated for making those decisions. Theirs is an impossible task - to be experts in all areas of the ever growing encyclopaedia of human illness. The review process should be sensitive to that.