The general practitioner referred Carol, aged four, for a psychiatric Tassessment, because:

… in the last three weeks she wakes up in the night, screaming and then goes into a trance-like state; her teachers say she is disruptive and naughty at school. Her mother has been advised by the school to seek professional help. Carol has had sodium cromoglycate and more recently terbutaline sulphate for chronic coughs and coughing on exercise, that I thought was asthma. We think she had chickenpox one month ago.

The phrasing of the letter clearly indicated that the doctor was agreeing to the referral, whilst reserving his views about the need for such a consultation: Carol’s school had recommended help, and Mrs C was prepared to accept this, so the doctor complied. An appointment was sent for Carol and her parents to come to the clinic.