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. 2002 Dec 7;325(7376):1359.
Copying letters to patients
Concerns of clinicians and patients need to be addressed first
Editor—Chantler and Johnson suggested that patients should receive copies of letters and summaries.1 We have researched this subject in our practice since 1998.2 Our experience of copying referral letters received such a positive response from patients that we have been doing this routinely for the past year and a half.
In a recent postal survey of 300 patients who had received copies of letters, 229 replied (response rate 76%), 220 (97%) of them saying that they would like to receive copies in future. Most of the respondents (184, 80%) believed that this should become routine NHS policy and should receive priority funding. Few concerns were raised about understanding the letters, and patients did not report increased anxiety; rather, they were reassured that their problem was being dealt with and they could understand why they were being referred.
Copying letters has not notably increased workload for doctors in our practice in terms of extra consulting time with patients, but financial costs are incurred in additional administrative time, stationery, and postage. We therefore broadly agree with Chantler and Johnson's argument that this is a policy that, if adequately funded, should be implemented forthwith.
We have, however, also just completed a series of interviews with a random sample of local general practitioners, all of whom raised some important concerns. They worry about how to write letters that are both comprehensible for patients and informative for professional colleagues, and how to avoid anxiety in patients when writing about tentative but potentially serious differential diagnoses. Issues about administrative resources also arise, and the question of maintaining the confidentiality of letters, especially for people who change addresses often. Particular patient groups who may have particular difficulties in accessing and understanding written correspondence include those with educational or visual disabilities, those with mental health problems, and those who do not have adequate reading skills in English.
Despite our wish to see this policy implemented nationally as soon as possible, we believe that it would be counterproductive to do this without first addressing the considerable concerns of both clinicians and certain patient groups. We hope that the pilot studies being funded by the Department of Health will identify the means of addressing these key issues and thus enable the successful implementation of this key initiative.
References
1.Chantler C, Johnson J. Patients should receive copies of letters and summaries. BMJ. 2002;325:388–389. doi: 10.1136/bmj.325.7360.388/a. . (17 August.) [DOI] [PMC free article] [PubMed] [Google Scholar]
2.Jelley D, van Zwanenberg T. Copying GP referral letters to patients—study of patients views. Br J Gen Pract. 2000;50:657–658. [PMC free article] [PubMed] [Google Scholar]
Editor—A year ago I chaired a multidisciplinary working group to advise officials at the Department of Health on implementing the policy in the NHS Plan that patients should receive copies of clinicians' letters about them. The group included clinicians, patients, administrators, researchers, and others. Its report was published on the Department of Health's website in March 2002 (www.doh.gov.uk/patientletters/issues.htm). Many organisations and individuals in the NHS are either already copying letters to patients, or keen to do so. Many have found the working group's report helpful in moving forward while more detailed guidelines are awaited from the department.
Chantler and Johnson's letter gives welcome recognition to the importance of this initiative.1-1 They refer with concern to a recommendation by the working group for further research. I would like to reassure them that the short term pilot projects now under way are intended as action research to help roll out the policy and inform particular aspects of the guidelines that need closer attention. They include issues around people who lack the mental capacity to give consent and people with different kinds of communication difficulties, among others.
I share their concern that this policy be rolled out as quickly as possible. I am committed to its importance as one means of improved communications with patients, enhancing their ability to share in the decision making process about their care and treatment and to make informed choices. But it is clear from the working group's debates that the many disparate organisations and institutions of the NHS are at very different starting points for implementation. It is encouraging that so many are anxious to continue or begin their efforts in this field, and that guidelines will be issued in the new year to bring others on board. I hope all those interested will read the working group's report.
References
1-1.Chantler C, Johnson J. Patients should receive copies of letters and summaries. BMJ. 2002;325:388–389. doi: 10.1136/bmj.325.7360.388/a. . (17 August.) [DOI] [PMC free article] [PubMed] [Google Scholar]
Editor—Chantler and Johnson urge that patients should receive copies of letters and summaries.2-1 For the past six years our eye department has been providing patients with a copy of their computer generated surgical discharge summary at the time of ward discharge. This is helpful when the case notes are missing at their follow up visit, ensures that postoperative treatment is prescribed legibly and in plain English, and includes OPCS4 (Office of Population Censuses and Surveys, fourth version) and ICD-10 (international classification of diseases, 10th revision) codes with 100% accuracy, according to a recent audit. Surgical complications and additional surgical procedures are also clearly stated, which ensures that these problems can be openly discussed with patients and their relatives.
We have generated more than 7000 such summaries and have received one letter of support from a local general practitioner congratulating us on the format of the summary. Most patients who have experienced complicated surgery ask for further information, and most are satisfied with the explanation provided. We have not yet been asked for a discharge summary in another language, which would probably exceed the capabilities of our 25 MHz 486SX personal computer.
When I was a house officer at Aberdeen Royal Infirmary in 1979, working for the late Professor Jim Petrie, discharge summaries were computer generated, although patients were not given a copy. We do not seem to have made a great deal of progress, and I share Chantler and Johnson's scepticism that further research is necessary before recommending the practice nationally. Unfortunately our experience shows that even when legible, accurate, and timely summaries are provided, no one really cares.
References
2-1.Chantler C, Johnson J. Patients should receive copies of letters and summaries. BMJ. 2002;325:388–389. doi: 10.1136/bmj.325.7360.388/a. . (17 August.) [DOI] [PMC free article] [PubMed] [Google Scholar]
