Anxiety can be induced in the doctor if too close a relationship with patients develops. This can lead to poor judgement, when the doctor feels pressurised into over-investigating or over-referring, rather than cope with the usual levels of uncertainty and timescales of general practice. This situation may also occur if the doctor is involved in treating his own family, neighbours or other members of the medical profession.
A cascade effect may follow the unnecessaty referral of a minor or vague complaint, the patient being passed from one consultant to another as they each find nothing positive to treat.
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