Arthroscopy in other countries: Presidential guest lecture

Abstract

American visitors to the United Kingdom are often surprised to learn that orthopaedic surgeons can only see patients referred to them by general practitioners. To see patients directly without a letter of referral contravenes the rules of the General Medical Council and could result in disciplinary action. A further, and more practical, disadvantage of seeing patients without a letter of referral is that they can only claim benefit from their private health insurance schemes if they are correctly referred by their general practitioners. This rule may seem oppressive and bureaucratic but is most effective in practice. The general practitioners are astute clinicians and refer patients with such accuracy that almost every new patient seen by a specialist has a problem in that specialist’s own area of knowledge. The result is an extremely efficient use of the specialist’s time. Another important difference in the United Kingdom is the shortage of specialist orthopaedic surgeons. We have one orthopaedic surgeon for every 70,000 people and the United Kingdom probably has the worst provision for elective orthopaedic surgery in the developed world. The result is a long wait for treatment. For example, patients to be seen in my National Health Service (NHS) Clinic must wait over 12 months for an appointment and a fur-