How Denmark’s specialist referral system works

One week during my nine-day tour I learned more about the Danish specialist referral system. It was a system so logical and patient-centered, it made me emotional about the chasm between what we have in Canada and what is possible. Here’s a summary of their system as I understand it.If a GP and patient determine that they need to consult another specialist about a problem, the GP makes a general referral to the specialty area and uploads it to a central database.Patients are then responsible for booking their own specialist appointments. They can use sudhed.dk to search all specialists in the country and can sort by distance and more. The info is also on the “MyHealth” app connected to sudhed.dk that Danes have for their medical records. (You can try it yourself by clicking here and picking a specialist or “behandlere”.)Wait time information, hours, accessibility and more are all transparent. The patient picks the specialist they want to see and calls the specialist's office directly to book.When a specialist gets a licence in a region, the region collects the office information and posts it online. Specialists are responsible for keeping it up to date and are incentivized to do so if they want referralsIf a patient doesn’t have a phone or access to the internet, they can use the public library system to access sundhed.dk. Library staff will help.If they still can’t use the system because, for example, they don’t speak Danish and are socially isolated, the GP office or municipality would support them. The same type of system is used to refer to hospital-based specialists, but it’s managed by the hospitals and not the individual specialists. If the person triaging the referrals thinks it’s been made to the wrong specialist, they will automatically redirect it.Contrast the Danish system with the Canadian one. I’ve heard time and again from patients how frustrating the referral processes are—they often have no idea what is going on and can be left in the dark for months.Read: Dr. Tara Kiran: How Denmark provides all citizens primary care accessAs an Ontario family physician, navigating referrals is one of the most frustrating and defeating parts of my job. We don’t have a directory of specialists or know the wait times or what type of referrals they accept. We pick someone and cross our fingers they say yes.The message “referral declined” has become increasingly common since the pandemic. It means we need to start the process again and the patient waits even longer. Office staff spend oodles of time communicating back and forth with the specialist office and patients. And I feel terrible that I can’t get the patient the help they need.I love that the Danish system is oriented to patients. Patients are in control—they have information to make choices and agency to follow through. It cuts out tons of back and forth. Yes, some people will need extra help but the efficiencies gained make that possible.It’s time to reorient our referral system to be more accountable to patients.Dr. Tara Kiran is a Toronto family doctor at St. Michael’s Hospital and the University of Toronto and leads OurCare—the largest pan-Canadian initiative to engage the public about the future of primary care in Canada.

How Denmark’s specialist referral system works

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