Dear Editor,The recent report on referral letter and reply form is very interesting.[1] Ramanayake et al., concluded that “a multicenter island-wide study should be conducted to assess the acceptability of the format to primary care doctors and specialists and its impact on reply rate.”[1] In fact, the referral from family physician to corresponding experts for proper management and follow up of the case is the main concept in family medicine. However, the big problem is “no information” notified from the consulted specialist. To get a reply is important for further following up in family medicine clinical practice. Ramanayake et al., proposed a new documentation system to solve the problem. In fact, the document might be a useful idea, but the rooted problem is due to the lack of intention of the specialist to write. Therefore, any more sophisticated document seems to be useless. The possible additional method might be the proposed new medical practice rule that the reply to referral case is mandatory, and it should be audited in any hospital accreditation.[2]