"Concerns about the referral system"

About: Box Hill Hospital

(as the patient),

Recently I attended my local GP to request to be referred to Box Hill Hospital Orthopedic's Outpatients Unit to have both my knees looked at due to the fact I suffer from chronic severe osteoarthritis in both knees with loose body in one knee and a small joint effusion in the other.  

Due to the fact I have a complex medical history and a few chronic conditions I am currently dealing with, the more serious one being a rare type of blood and bone marrow cancer (myeloidproliferative neoplasm) that could be causing the osteoarthritis to flare up and be extremely painful and causing some of my other health conditions to play up. My GP put in the request outlining in the referral my health details and wishing for me to be reviewed in a timely manner (I believe at this referral the GP had requested an urgent review).

Another reason I requested to be referred to Box Hill is because in 2007 the very lovely late Mr Michael did a H.T.O (High Tibial Osteotomy) on my left knee and more surgery in 2009 to remove the plates and screws in the same left knee, that it made sense to ask to be referred back to the hospital because they have the original history about my knees.

After the referral was sent in to the hospital back in mid 2018 it took the hospital two weeks to reply back to my GP requesting more information from her which she promptly forwarded on, requesting again that I be seen quickly. After this second request was put in, it took another 4 weeks before I received a letter from the hospital. Nothing was sent to my GP informing them that I had been placed on a waiting list.

When I received the letter I was shocked at how small the written font on the letter was, which made it quite difficult to read (had to read the letter many times to try and find out which clinic wait list I was on).

Also, it was very upsetting to read that the hospital does not view my health conditions as urgent or serious when in fact they are and are impacting on my quality of life.

I also found the wording of the letter vague where it says there is no need to do anything and there is no guideline as to how long one is expected to wait for an appointment. Like are we expected to wait weeks, months,  years for an appointment?

A few days ago I had to see my GP again for another health matter and she asked if I had been given a date yet to be seen at Box Hill. When I informed her no and that I was on a waiting list she was not happy considering she had requested an urgent review. When I showed her the letter she was not impressed as she was under the impression that with her forwarding on more information to the clinic when requested that it would have meant that they would review and give me an urgent appointment not be placed on the wait list. 

As a result of this my GP has now been forced to try and contact the head of the unit of orthopaedics to question why? She has also encouraged me to leave this view here in the hope that the hospital will review its referral process from a GP, especially if a GP has requested more than once for a patient to be seen quickly. Not just discarded and put on a waiting list where it could be months or years away before being seen. I did inform my GP I was happy to wait, but she doesn't want me to wait too long because she is quite concerned that the longer I wait the worse my other conditions could become.

So as a result of these current events I would like to make some suggestions.

1. That notification letters from the hospital be typed up in a slightly larger font as the current font is extremely hard to read. Also the name of the clinic that a patient has be referred to be typed in larger bold font so that it stands out and so clients / patients know the name of the clinic instead of trying to guess.

2. That the hospital seriously consider listing on their website, as well as letters, how deaf and hard of hearing patients can contact the hospital outpatient clinics. As for some deaf and hard of hearing patients trying to understand or hear on a phone is very challenging and could cause misunderstanding, etc. Having a service for the heard of hearing to contact to get info would make a huge difference. Currently on the website it says if you have special needs phone this - as I said is not always practicable. Maybe an email address could be made available?

3. If a GP puts in multiple requests for an urgent appointment and the hospital thinks the referral is not urgent, then the hospital department where the referral was made needs to contact the GP and inform them the reason why, with maybe some suggestions or guidelines as to how to help the patient cope with things during the wait time.

4. Could the hospital review the way they triage the outpatient orthopaedic clinic or when they send out waiting list placement letters? That they get rid of the negative wording -  you have been assessed as not urgent. This is upsetting for patients to read and sounds uncaring. Maybe it could be reworded with something along the lines - we have assessed your condition and we aim to see you within 30 days for the urgent cases and within such and such time for those that are not urgent.

5. Could the hospital at least inform people on the website or to the referring doctor the rough time frame of how long one is expected to wait on wait lists for an outpatient appointment. Having this information even if it is a rough guideline helps the GP and other doctors arrange suitable help for there patients while they are waiting to be treated and also helps to inform patients that they are not forgotten etc.

On a more positive note I would like to thank Box Hill Hospital management team for making an effort to read nearly every patient review on this site and responding. A lot of hospitals don't seem to bother reading or replying back, so thank you for doing that.

I live in hope that I get an answer soon as to when I will be seen for my problem.

Thank you for taking the time to read this long post and I hope some of my suggestions will be taken on board and viewed, especially the bit that better communication needs to happen between referring GP's and the outpatient clinics.


Response from David Plunkett, Chief Executive, Eastern Health We are preparing to make a change

picture of David Plunkett

Dear sore knees

Thanks you so very much for taking the time to share your feedback and comments with regard to your previous and current experience with our services at Box Hill Hospital.

Firstly, thank you for your very balanced comments and also for the positive comments you've made. You have also made a number of suggestions regarding what we could look to improve. It will give me great pleasure to share these with the leaders for the Specialist Clinics so they can review what we can do.

I note your GP's view re. you needing a more timely appointment and is doing the best thing in making sure they can have a detailed discussion re. your clinical condition.

Many thanks again.

Kind regards


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Update posted by sore knees (the patient)

Dear David,

Thanks for your reply. While my GP is still trying to sort things out with the Orthopaedics Outpatient Clinic, my GP has now referred me to other hospital Orthopaedic Clinics in the hope they can see me quicker than what Box Hill Hospital is to date unable to offer. I have kept myself on the Box Hill wait list, but if an offer comes sooner for an appointment from another hospital, I will be have to take up there offer, even though I really would like to have my knees treated and hopefully fixed at Box Hill. So I will keep hoping the wait won't be much longer for hearing back with an appointment from this clinic.

I am happy that my suggestions are going to be put forward to the clinics and look forward to reading or seeing if any of the suggestions will or can be taken up to better the patient experience.

Thanking you again.

Regards Sore Knees

Response from David Plunkett, Chief Executive, Eastern Health

picture of David Plunkett

Dear sore knees

Thank you again for your comments and suggestions. I am pleased to provide this update to you.

As a result of your feedback the Specialist Clinics (Outpatients) team are commencing an improvement project focusing on the patient experience. This project will encompass from first contact (such as letters) to when a person no longer needs to attend the doctor or clinic. The focus of this project will cover Specialist Clinic services at all Eastern Health hospitals including Box Hill, Maroondah, Angliss and Healesville Hospitals as we all as Yarra Ranges Health.

I hope your appointment is getting close, if not completed (at whichever hospital it is) and you are on the next stage of your care and treatment.

Kind regards and many thanks


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Update posted by sore knees (the patient)

Thanks David,

For updating me on this. Hopefully this will improve things for everyone going through the outpatient clinics. I still have not had my outpatient orthopaedic appointment yet. (It is challenging trying to be patient when in daily pain). It is now well and truly over 90 days of waiting for this appointment so really needs to be worked on the waiting times. I understand that trying to improve all this takes time etc. and doesn't happen overnight. So thanks again for at least trying to make improvements within your hospital, it is much appreciated by me. P.S. I apologies if I come across grumpy, do not mean to be, just living with daily pain can make one grumpy. Will keep patiently waiting for appointment. Hopefully am getting closer to appointment.