Dear Doctor, In Australia, we have a clear template of the standard referral pathway. General practitioners refer to specialists, who refer to sub-specialists. Whenever we feel we need a more specialised opinion than our own we refer the patient to a colleague along this pathway. We can often choose to whom we refer; we may value a particular practitioner’s expertise on a particular matter, or we may know that someone may suit the patient best. This is most evident in the private system. There are also times when we don’t get a choice, a patient has to be referred to a general service in the public system. While this may have issues, there are often benefits, and there are many times when referring a patient to the local public hospital service is in their best interests.