referitis

Referitis is a coined term used to describe a pattern in clinical practice in which healthcare providers repeatedly refer patients to specialist consultation and diagnostic testing for conditions that are likely to be benign or self-limited, often due to diagnostic uncertainty, defensive medicine, or patient expectations. The term combines referre (to refer) and -itis (a suffix indicating inflammation or disease) to evoke an ongoing process of referral.

Signs and symptoms described in the literature include elevated referral rates, multiple concurrent specialist consultations, repeated imaging or laboratory testing, prolonged diagnostic pathways, and minimal primary-care management between visits. It is not a recognized disease by major medical bodies, but a descriptive concept.

Causes of referitis are attributed to uncertainty in presentation, limited access to definitive diagnostic pathways, time constraints, fear of missing a serious disease, patient demand, and fee-for-service incentives that may reward more procedures.

Impact of referitis on health systems can include increased costs, patient exposure to unnecessary tests, and potential harm from incidental findings, as well as patient anxiety. Some referrals, however, may be appropriate, particularly for red-flag symptoms or complex comorbidity.

Diagnosis of referitis is not based on a specific test. It is identified through health-system data, audits of referral patterns, or clinician self-assessment. Distinguishing referitis from appropriate care relies on guideline concordance, outcome data, and alignment with patient-centered goals.

Management emphasizes primary-care gatekeeping, use of clinical guidelines, structured referral criteria, multidisciplinary case reviews, and shared decision making. Education about the benefits and risks of testing, and setting expectations with patients, are commonly recommended components.