> Canonical: https://drkishanrees.com/ideas/referrer-society/

# The referrer society

Coined in my MD thesis, Hull York Medical School, 2025

**A referrer society is one in which people no longer simply accept what
authority tells them: they check, compare, and increasingly ask an AI. The
deferrer society it replaced simply accepted.** The terms are from my MD
thesis, which found that COVID-19 completed this shift in how people seek and
verify health knowledge.

## Where it came from

The pair of terms comes from my doctorate, 'Exploring Medical Communication &
Media Influence on Public Health Perceptions During the COVID-19 Pandemic'
(MD, Hull York Medical School, 2025). Fifteen months into the pandemic I
interviewed 40 people, 20 healthcare professionals and 20 members of the
public, and analysed their accounts using interpretative phenomenological
analysis. Here is the finding as the thesis states it:

> The research demonstrates a fundamental shift from a 'deferrer society' to
> a 'referrer society' in public health communication, necessitating new
> approaches to crisis communication that can harness social media's speed
> and reach while maintaining message integrity.

The full 306-page thesis is self-hosted, with its abstract, at
[the research page](/work/research/).

## The argument

My grandfather's generation deferred to the doctor. Ours refers: to search
engines, to each other, and now to language models. Health communication that
assumes deference is speaking to a society that no longer exists.

The interviews showed the shift from both sides. Healthcare professionals
evaluated information in more sophisticated ways but struggled to bridge
professional knowledge and public understanding; the public was more
vulnerable to misinformation but grew steadily more critical in how it
consumed media; and both groups' trust in different sources kept evolving
through the pandemic. Neither group was waiting to be told.

The conclusion is not that authority should fight the shift. It is that
communication has to work with it: harness the speed and reach of the
channels people actually refer to, keep the message intact while doing so,
and balance traditional authority with the collaborative ways knowledge is
now made. The newest referral destination is the language model, which is why
I later coined [B2LLM](/ideas/b2llm/): when the answer comes from a model,
the model is the reader you have to reach first.

## Who it is for

The evidence base is health communication, and health communicators are who
the thesis addresses: if your audience checks before it trusts, assuming
deference means talking to a society that no longer exists. But the shift
changes what it means to communicate anything, to teach, to publish. Whoever
your audience is, if they arrive having already checked, compared and asked a
model, you are working in a referrer society. That wider application is my
read, not the thesis's finding; the ledger below says so.

## What the referrer society does not claim

Naming a shift is not a licence to overstate it, so let me be precise about
the edges.

- It does not claim deference is dead. The study found trust evolving, not
  vanishing; the term names the direction of travel.
- It does not claim referring is automatically wiser. The same study found
  the public more vulnerable to misinformation even as it grew more critical;
  checking can land on a falsehood as easily as a fact.
- It does not claim statistical generalisability. Interpretative
  phenomenological analysis is idiographic: 40 people in depth, not a
  population survey.
- It does not claim the shift is proven beyond health. That is where the
  evidence is; the wider application is my hypothesis.

## The claims, classed

I sort what I publish by how strong the claim is, so here is this page graded
by my own rubric. The classes are Observation, Hypothesis, Coined term,
Internal result and Externally validated finding; each claim names its
evidence and where that evidence comes from.

### The ledger

**The terms themselves, deferrer society and referrer society.** Coined term.
Evidence: the thesis, formal title above, examined and awarded in 2025.
Source: owner-supplied document, self-hosted in full at
[the research page](/work/research/); the degree award is the institutional
check.

**COVID-19 completed a shift from a deferrer society to a referrer society in
health communication.** Internal result, institutionally examined. Evidence:
the thesis, an IPA study of 40 participants. Source: owner-supplied document;
the degree award is the institutional check, not external replication.

**What the two groups showed: professionals more sophisticated but struggling
to bridge; the public more vulnerable but growing more critical.** Internal
result, from the same study. Evidence: the thesis results, summarised in its
abstract. Source: owner-supplied document; the same institutional check.

**People increasingly ask an AI.** Observation. Evidence: my own practice and
the Reuters Pharma panel where I coined B2LLM; the third-party usage figures
quoted there are attributed on that page, never asserted. Source:
owner-supplied recordings; not independently verified.

**Every audience that used to defer is now referring.** Hypothesis. Evidence:
the argument on this page. Source: my own proposed generalisation, not yet
validated; this page will say so until that changes.

## Watch and read

- The thesis itself: [Public Health Communication During
  COVID-19](/work/research/), MD, Hull York Medical School, 2025, with its
  abstract and the full 306-page PDF
- Where the idea leads: [B2LLM](/ideas/b2llm/), the channel to the newest
  referral destination
- The human arc: [My story](/story/), from my grandfather's generation to
  this one
- The working experiment: [this site treats models as a third
  audience](/colophon/)

Cite as: Rees, Kishan. 'The referrer society'. drkishanrees.com, first published 17 July 2026. https://drkishanrees.com/ideas/referrer-society/