The aims of the present study were to assess the frequency of examinations or tests before referral for a barium enema, to identify predictors for the use of such examinations or tests and to evaluate the quality of the referral letters. 1852 patients completed a questionnaire on symptoms and examinations or tests performed before referral. Symptoms, examination procedures, laboratory data and reason for referral were registered in 1781 referral letters and were compared with the information given by the patients. Serum haemoglobin was measured in 76, per-rectal examination in 45, faecal occult blood tests in 37and proctosigmoidoscopy in only 16of the patients. High age was a significant predictor for all examinations, and patients with rectal bleeding and rectal pain were more often examined rectally, although this was omitted in several patients with such symptoms. All evaluated information was reported significantly more frequently by the patients than by the doctors in the referral letters. The very low figures for rectal examinations and the lack of completeness and adequacy of the information in the referral letters underline the need for efforts to change doctors' behaviour when investigating and referring patients with possible colorectal disease.
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