Background: The referral letter serves a central role in the transfer of patients from referring doctors to specialist care in Australia. Aim: We analysed the form and function of referral letters and examined their role in surgical consultations to better understand the information in the letter and what impact that may or may not have on consultation openings. Methods: Thirteen referral letters and their associated recorded surgical consultations were analysed with an iterative, multi-methods qualitative approach. Using inductive and deductive linguistic methods, we considered clinical and paraclinical information as well as contextual factors in the letters’ alignment with referral guidelines as well as overall relevance to the consultation. Results: The analysis showed that surgeons tend to have a “set piece” when opening a consultation that is independent of the content or style of the referral. While referral letters fell short of guidelines, additional patient information was frequently discussed in the consultation. Discussion: Patients and surgeons are generally able to work around interactional challenges related to patient information. However, recognising the need to supplement referral information particularly around paraclinical information and contextual factors is important. Conclusions: Future changes to referral letter guidelines could reflect these realities
