Dr. Brendan O'Shea:

It is there and we know what it is. A common reason we refer more is that when one becomes significantly distressed and stressed, one's perception of clinical threat becomes higher. If one is working a 50 or a 60-hour week, doing paperwork out of hours and then going on to one's co-operative to do a four-hour shift and doing the same workload the next day and day after and worrying about the different issues with which one is dealing because there are not enough GPs in the practice, then one will tend to refer a little bit more. That is one of the well understood reasons we refer more.