Often the GP will have no real knowledge of the specialist that he is referring his patient to. He will not have met him in person and certainly has no idea whether the specialist is up to date or competent. In many GP medical centres, there is a database of specialists - the GP will often just look this up and refer to whoever comes up. You have to understand that the GP is sitting in his own office pumping through 50 patients a day whilst the specialist is doing the same. Never do the two meet. As a GP, you refer patients to a whole different array of specialists: dermatologist, surgeon, cardiologist, radiologist - it is impossible to know anyone. It is only if the patients keep coming back from the same specialist with complaints does an alteration of referral pattern changes. Otherwise, the GP will refer to the same specialist that he is referring to for the past ten years. That is why many new and existing specialists invest heavily in marketing to GPs in order to generate referral leads.