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. 1998 Jun 13;316(7147):1830. doi: 10.1136/bmj.316.7147.1830b

Providing letters to patients

Patients find summary letters useful

N Hallowell 1
PMCID: PMC1113338  PMID: 9624093

Editor—Essex raises some interesting points about the value of giving patients a written summary of their consultation.1 The practice of sending patients a letter summarising their consultation is very common in genetic counselling.

A colleague and I have completed a qualitative interview study exploring patients’ attitudes about and their use of written summaries of their genetic consultations for hereditary breast and ovarian cancer.2 Like Essex, we found that patients responded very positively to these letters. Altogether 37 (93%) out of 40 patients in the sample said that the summary letter aided their understanding or recall of information that had been given in the clinic, or both. The written summary was also perceived as valuable because it could be shown to other clinicians to support the patient’s case for gaining access to breast or ovarian screening programmes, it reassured patients that they were taking appropriate action, and it contained information about other relatives’ risks. In addition, the written summary was also perceived as a useful tool for disseminating genetic information to other family members; 34 (85%) out of 40 patients said they had used, or intended to use, the written summary of their counselling session to facilitate the communication of genetic information to other biological relatives.

On the basis of our findings we suggest that genetic counsellors send patients a letter summarising their consultations as this may result not only in an increase in the patient’s understanding, but may prevent the miscommunication of genetic information within the family. However, we feel that clinicians should be aware that providing patients with a written summary of their consultation may also have negative consequences. It may generate an inappropriate demand for referrals to genetic clinics from family members at low risk, and, more importantly, reading a letter written to the patient may cause needless anxiety among low risk family members.

References

  • 1.Essex C. Consultants could give patients a letter summarising their consultation. BMJ. 1998;316:706. doi: 10.1136/bmj.316.7132.706. . (28 February.) [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Hallowell N, Murton F. The value of written summaries of genetic consultations. Patient Education Counselling (In press.) [DOI] [PubMed]
BMJ. 1998 Jun 13;316(7147):1830.

GPs can be given copies of letters sent to patients

M D Lewars 1

Editor—I would like to reinforce Essex’s opinion that consultants should write letters to their patients summarising their findings after a consultation.1-1 Since starting the breast screening service in South Essex in 1990, it has been my policy to write to women who have been assessed and whose abnormalities have been found not to require surgical evaluation or treatment.

Initially, I also wrote letters to the woman’s general practitioner but I have since found this to be an unnecessary waste of resources. I now write to the woman and send a copy of the letter to her general practitioner. This ensures that the general practitioner knows exactly what the woman has been told and it provides a record of the procedures undertaken and the advice given on future management.

There has been a mixed reception to the letters. One group of general practitioners praised their clarity while another complained about their technical detail. I hope modifications made in response to these comments have made the letters more comprehensible to both the women and their general practitioners.

References

  • 1-1.Essex C. Consultants could give patients a letter summarising their consultation. BMJ. 1998;316:706. doi: 10.1136/bmj.316.7132.706. . (28 February.) [DOI] [PMC free article] [PubMed] [Google Scholar]
BMJ. 1998 Jun 13;316(7147):1830.

Summary letters may be especially appropriate after emergency admissions

Nicholas Coni 1

Editor—It is common for professionals such as accountants and solicitors to follow a meeting with a client with a letter recapitulating the points discussed, and Essex is to be congratulated on his initiative in doing the same after paediatric outpatient appointments.2-1 Communication is especially important at either end of the age spectrum, and some years ago two of the four geriatric teams in our hospital decided to send out letters to patients who had been seen for consultations. The letters were sent after the initial visit and also when results came back or decisions were arrived at which might have made a further letter helpful. Altogether, 79% of 35 patients found the letters “very helpful” and 18% found them “helpful.” Questionnaires were also sent to 38 patients in a control group. In this group, 74% indicated that a letter would have been “very helpful” and 23% indicated that it would have been “helpful.” We sent separate letters to the patients’ general practitioners together with a copy of the letter sent to the patient.

It was a valuable exercise in communication skills, but we had to discontinue the practice due to the need to reduce the secretarial (and medical) workload. Perhaps it would be even more useful to send a similar letter after an emergency admission, since so much of what has happened becomes eclipsed by subsequent events, and memories of procedures and discussions so readily become blurred.

References

  • 2-1.Essex C. Consultants could give patients a letter summarising their consultation. BMJ. 1998;316:706. doi: 10.1136/bmj.316.7132.706. . (28 February.) [DOI] [PMC free article] [PubMed] [Google Scholar]
BMJ. 1998 Jun 13;316(7147):1830.

Letters should be used carefully

J A Eaden 1, B Ward 1, J F Mayberry 1

Editor—We were interested to read that Essex advocates giving patients a letter summarising their outpatient consultation.3-1 Several authors have already conducted research in this area.3-2,3-3 We agree that it is of paramount importance that doctors communicate with patients to ensure patient satisfaction and enhance the relationship between doctor and patient. However, if we were to send each patient a letter summarising their consultation the workload that would be generated would be unacceptable both from the medical and secretarial viewpoint, and this procedure is unlikely to be economically viable.

In our work with gastroenterology patients attending outpatient appointments we found that large numbers of patients wanted to receive more information about their condition, its investigation, and its management.3-4 We achieved the same degree of patient satisfaction by providing patients with a copy of the letter that was sent to their general practitioner as when we posted them a separate, tailor made letter.

There are many benefits to patients receiving a copy of the letter sent to their general practitioner: they are able to build their own copy of their medical record, their knowledge increases, and it reminds them of the details of the consultation (as we all know patients may find it difficult to recall details of consultations especially when the subject is emotive).

As patients want more information it becomes our duty to provide it. However, when communicating with patients by sending them copies of letters sent to their general practitioners the potential for generating anxiety is introduced as some patients will have serious diseases. We advocate sending patients a letter to reinforce what has already been discussed during an outpatient consultation, but believe that doctors should be careful of introducing new information or breaking bad news in a letter as this would be unethical and uncaring.

References

  • 3-1.Essex C. Consultants could give patients a letter summarising their consultation. BMJ. 1998;316:706. doi: 10.1136/bmj.316.7132.706. . (28 February.) [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3-2.Rylance G. Patients’ right to know. BMJ. 1990;300:608–609. doi: 10.1136/bmj.300.6724.608-c. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3-3.Tattersall R. Writing for and to patients. Diabetic Med. 1990;10:917–919. doi: 10.1111/j.1464-5491.1990.tb01330.x. [DOI] [PubMed] [Google Scholar]
  • 3-4.Eaden JA, Ward B, Smith H, Mayberry JF. Are we telling patients enough ? A pilot study to assess patient information needs in a gastroenterology outpatient department. Eur J Gastroenterology Hepatology. 1998;10:63–67. doi: 10.1097/00042737-199801000-00012. [DOI] [PubMed] [Google Scholar]

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