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An experienced seminar made a special study of the psychological aspects of referrals for second opinions, investigations, or hospital admission. The cases were a random selection, incidentally forcing the seminar to examine some of the poor medical practice that is rarely published and to recognise the disturbing force of the doctor-illness relationship, as distinct from the doctor-patient relationship. General practitioners use referrals in many ways and select consultants for quite unexpected qualities, often to preserve the relationship with their patients, and contrary to many superficial impressions otherwise. Referrals are part of the continuous flux of patients in and out of a doctor's life and this movement is important to his sense of identity and to his defences against anxiety.