OBJECTIVES: To delineate family physicians' and rheumatologists’ point of view when primary care is facing cases of rheumatic diseases. To experimentally identify barriers in the reference and counter reference. METHODS: This is a pilot study, transversally designed, with family physicians and rheumatologists in a single city. Methodological steps: 1) Development and preparation of three clinical scenarios that simulate and address different levels of clinical severity; 2) application of these scenarios in the sample; 3) validation of the study scenarios. Final scenarios: a) Scenario one: patient with an autoimmune disease diagnosis presenting fever and fatigue; b) Scenario two: patient with fibromyalgia and with poor adherence to the healthcare plan, requiring a medication to relief the symptoms; c) Scenario three:patient with septic arthritis, prostration, and in poor clinical conditions. Decisions to be chosen: Decision 1: To apply a healthcare plan (investigation and/ or treatment) and refer to a rheumatologist; Decision 2: to prescribe medication and do not reference to rheumatologist; Decision 3: to refer to a rheumatologist with no primary care intervention. Afterwards, a multiple-choice questionnaire addressing potential factors that lead to barriers in the reference and counter reference process was applied. Descriptive analysis was performed to map the results and bootstrap method for constructing hypothesis tests. RESULTS: Twenty-two family physicians and rheumatologists were involved. For Scenario one, the majority of interviewee chose Decision 1 [1.27 (1 –3), SD 0.59)]. For the Scenario two, respondents chose the decision 2 [2 (1 – 3), SD 0.76)]. For the Scenario three, decision three was the preferred [1.47 (1 –3), SD 0.83)]. For the reference and counter-reference evaluation, interviewee considered that there is a poor communication between family physician and rheumatologist [4.2 (2 – 5), SD 1.01)]. CONCLUSIONS: Proper communication seems to be a hurdle for the reference and counter reference system.