A common practice in WA public hospitals is to divert as many costs as possible to private and Commonwealth sources.

In the early days of Medibank, privately insured patients were often not offered a choice — they were simply classified as private.

As a result, hospital consultants received two kinds of referrals: real and fortuitous. The real ones were letters addressed directly to the consultant.

The fortuitous ones were patients admitted to the public hospital who happened to be privately insured. These were ‘referred’ by a consultant’s registrar. My mentor and colleague, the late Professor Richard Joske, called them “faux referrals”.