Sadly, having worked as a junior doc on a busy Surgical Assessment Unit, crap GP referrals are the norm. What we often get is a "Dear Doctor" letter, followed by a bit of barely legible scrawl and a request to "do the needful". Oh, thanks! Occasionally, we get a really good one: a print out of the Pt's medications, recent history and, (yes dear reader!), sometimes even examination findings and differential diagnoses. The worst one I can think of is a lady with right upper quadrant pain & jaundice, with a past history of bladder cancer. The GP helpfully told the family (but not the Pt!) that this was definitely metastases from her previous cancer and that it was almost certainly inoperable. What did she actually have? Gall stones... I felt like ringing the GP up and giving her a bollocking. But that wouldn't have gotten me anywhere.