Document Type: Letter to Editor


1 Quality Improvement in Clinical Education Research Center, Education Development Center, Shiraz University of Medical Sciences,

2 Endocrinology and Metabolism Research Center, Nemazee Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran;

3 Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran;

4 Department of Pediatrics, Namazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran;

5 Department of Internal Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran


Health care system is organized to achieve more efficiency as well as developing public equity and providing access to the first, second and third levels of services. Family physician is in the first line of the health care system; in other words, family physician is the health system’s goalkeeper. According to classification of health services, gaining access to specialized services becomes possible through the referral system.1 Referral system is a system in which the client should primarily refer to the family physician in order to gain access to health care services and be referred to a specialist if necessary. The specialist refers the patient to the family physician for following treatment modalities after doing necessary medical care and advice and recording the results in the feedback form.2 Despite the different levels of service delivery, the boundaries between these levels are not clear enough and have caused problems in the referral system. Certainly, for better implementation of family physician plan, empowering family physicians, clarifying the referral procedure, and localizing its components are of great importance. One of the life long concerns of the Ministry of Health and Medical Education, especially Shiraz University of Medical Sciences, has been developing clinical guidelines to empower family physicians based on clinical referral system and local conditions of the country. Among effective measures in this field is preparing clinical guidelines, according to the level of services and in line with the referral system. The purpose of developing clinical guidelines is improving the quality of health care and increasing the patient’s satisfaction through the following specific objectives:

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