interviews with prisoners of war, John Heiden- reich, an American .... 2 Stratton M, Evans DJ, Lampert I. Prostatic adenocarcinoma evolving into carcinoid: ...
all that is private is bad-an unfortunate throwback to Nehru's era of pseudosocialism. Reality is very different, with most government teaching hospitals being poorly equipped, maintained, and staffed. On the other hand, some private institutions, like the Kasturba Medical College at Manipal, are acknowledged to be among the best in the country. Thirdly, the judgment provides that half of the seats will be filled by students who will pay the same fee as that levied by the state subsidised government colleges. This ignores the fact that the private colleges do not enjoy any subsidy and that therefore, in effect, the educational expenses of these students will be met by the other half, who will pay a higher fee, and this is in no way fair. Instead of taking a futuristic view the Supreme Court has taken an unfortunate step backwards. E S KRISHNAMOORTHY C S SANJAY
Department of Psychiatry, Kasturba Medical College Hospital, Manipal-5761 19, Kamataka, India I Nandan G. India to check sale of place in medical colleges. BMJ
1993;306:604-5. (6 March.)
Communication between GPs and psychiatrists EDITOR,-The title of Peter L Cornwall's paper implies that his study looked at the quality of communication between general practitioners and child psychiatrists.' The study assessed the content of 50 referral letters and shows how general practitioners and consultants differ on what should be included in such letters. These differences could be accounted for by factors such as training, knowledge, experience, and expectations in one's specialty and do not necessarily imply lack of communication. We audited the quality of referral letters from general practitioners to a sectorised mental health team in Nottingham before and after a guide for referrers designed to improve referral practice was sent out. We studied referrals during three periods, each of three months' duration, starting mid-October 1990, April 1991, and April 1992. The guide for referrers was sent to the general practitioners in January 1991, the end of the first period. The general practitioners were asked to include information considered to be useful by Pullen and Yellowless.2 There were 27, 24, and 36 referrals in the three periods. Three quarters of these referrals (65) were from general practitioners. The reason for the referral and the main symptoms were the items most commonly mentioned in the letters. The presence or absence of a family history was mentioned in only two (3%) of the letters. These results confirm Cornwall's findings. Medication was mentioned in at least 60% (n=48) of the referral letters, compared with only 18% in Cornwall's study. Perhaps the general practitioners did not consider this item to be relevant for child psychiatrists, who use drugs less than adult psychiatrists do. Psychiatric history was mentioned in only four (20%) of the referrals in the first period; this figure is lower than that of Cornwall, although his figure includes both medical and psychiatric history. The frequency of mention of this item significantly increased to 57% (n= 15) in the third period in our study (p
