The referrer society
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.
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: 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; 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, MD, Hull York Medical School, 2025, with its abstract and the full 306-page PDF
- Where the idea leads: B2LLM, the channel to the newest referral destination
- The human arc: My story, from my grandfather’s generation to this one
- The working experiment: this site treats models as a third audience