What PCPs and psychiatrists say referral letters should contain

When a primary care physician sends a patient to a psychiatrist, the referral letter is often the first thing the specialist reads. A qualitative study published in BMC Primary Care set out to determine what should actually go into those letters, by asking the two groups who write and read them. The researchers conducted semi-structured focus groups between October 2024 and March 2025, recruiting 17 primary care physicians and 15 psychiatrists through purposive sampling. Each group contained four to six participants, and the interviews were conducted by two primary care physicians, transcribed, and analyzed using framework analysis.

The study identified 18 items that participants expect to see in a referral letter, along with 7 themes describing the attitudes physicians bring to writing them. Among the expected contents were the patient’s profile, physical information to facilitate the psychiatrist’s practice, family composition and dynamics, assessment and diagnosis, symptom descriptions built from concrete episodes or the patient’s own words, the reason for referral, the referring physician’s intention to remain involved after the handoff, and medication history. These categories were identified through the framework analysis of the focus group data.

Not every expectation aligned across the two professions. Primary care physicians worried that stating their own assessment and diagnosis might steer or constrain the psychiatrist’s clinical judgment. According to the study, the PCPs' concern that their assessment and diagnosis might influence the psychiatrist's practice was not borne out. The study found that PCPs were concerned their description of the assessment and diagnosis might influence the psychiatrist's practice, but this was not the case.

Prescription history revealed a second disconnect. Psychiatrists wanted more detail about what medications a patient had previously taken, but primary care physicians did not provide that level of specificity in the letters they described. The study found that psychiatrists wanted to receive more details regarding prescription histories, but PCPs did not provide them.

The attitudes physicians hold toward letter writing formed the study’s second major finding. Primary care physicians described taking the initiative within the scope of their own medical practice, and they also described making deliberate adjustments to keep the letter brief while still conveying the purpose and intention of the referral clearly. The PCPs' attitudes toward writing referral letters included making adjustments and considerations to ensure a brief but clear description of the referral purpose and intention.

The interviews were transcribed and analyzed using framework analysis. Participants were recruited by purposive sampling, so the findings reflect the perspectives of those who took part rather than a representative sample of all physicians.

The study’s conclusion is direct: information provided by primary care physicians can benefit psychiatrists, and stronger communication between the two groups is needed so that referral letters adequately address the informational needs of the receiving specialist. Referral letters are used as a basic form of communication between PCPs and psychiatrists in collaborative mental health care.

The study does not measure whether better letters improve patient outcomes, and it does not test any intervention. It documents, through structured qualitative analysis, where the expectations of letter writers and letter readers diverge. The identified 18 content items and 7 attitudinal themes describe what PCPs and psychiatrists believe should be included in referral letters and their attitudes toward writing them.

The work was published as open access research in BMC Primary Care on 4 November 2026, with Natsuki Kajikawa, Hisashi Yoshimoto, Noriyuki Kimura, Ryuhei So, Masahide Koda, and Shoji Yokoya listed as authors. The published version notes that it is an early-release, citable version carrying a permanent DOI, subject to further edits before the final Version of Record replaces it. The study concluded that stronger communication between PCPs and psychiatrists is needed to ensure referral letters adequately address psychiatrists' informational needs.

Subject of Research: What primary care physicians and psychiatrists believe referral letters should contain

Article Title: A qualitative study on the contents of referral letters from primary care physicians to psychiatrists

Article References: Kajikawa, N., Yoshimoto, H., Kimura, N., So, R., Koda, M., & Yokoya, S. (2026). A qualitative study on the contents of referral letters from primary care physicians to psychiatrists. BMC Primary Care. https://doi.org/10.1186/s12875-026-03612-y

Image Credits: AI Generated

DOI: 10.1186/s12875-026-03612-y

Keywords: referral letters, primary care physicians, psychiatrists, mental health care, qualitative study, focus groups, framework analysis, communication, prescription history, BMC Primary Care, qualitative, contents