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Jim You wrote... <The fact is though that we need them more than they need us and until there is a radical change in their teaching and thought processing, they will not, at least as a group, meet us half-way. I don't think that we need to degrade what we do and how we think but we do need to upgrade our skills as translators for these people.> I know exactly what you're saying. Doctors see us as semi-autonomous beings that do what we like anyway - which I think is a good thing. One of the reasons for this is that they know they cannot prescribe to us. For many a year we have resisted the temptation to be told what to do. I'm suggesting we should do the same thing here. Don't give objective referral criteria - spend your time educating them about the importance of a well funded support system like on-call and make sure that you deliver a high quality responsive service - then you hopefully won't feel the need to lay down criteria that limit what you might do. As Harry Chapin once said... it's about time we started to look at why the laundry's getting dirty, rather than keep sending it to be cleaned. Dave Nicholls %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%