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. 2003 Feb 22;326(7386):449. doi: 10.1136/bmj.326.7386.449

Copying letters to patients

Psychiatrists omit information from letters when they know patients will be sent copies

Graham K Murray 1,2,3,4, Harpal Nandhra 1,2,3,4, Nigel Hymas 1,2,3,4, Neil Hunt 1,2,3,4
PMCID: PMC1125328  PMID: 12595396

Editor—From April 2004 patients will receive copies of all correspondence between clinicians working in the NHS as a matter of course.1,2 Previous research supports the view reported in Eaton's news item that patients appreciate this practice3–5; however, the way its national introduction will affect doctors' work is much less clear. We audited how psychiatrists' practice is affected when letters are to be copied to patients.

All 76 new patients who attended two general psychiatry outpatient clinics (one rural, one inner city) from January 2002 to July 2002 were included in the pilot study, as were all eight psychiatrists who worked in these clinics during this time. After the assessment patients were sent a copy of the psychiatrist's letter to the general practitioner and asked to complete a short questionnaire on their evaluation of the letter. Psychiatrists were asked whether anything of importance had been omitted from the letter that they would usually have included, and if so, the reason and how the omitted information would be communicated to general practitioners.

Fifty six of the 76 letters (74%) were sent to the patient in an unaltered form (table). In three cases the psychiatrists thought it inappropriate for the patient to receive a copy of the letter, citing concerns over patients' distress. In 17 cases clinicians made omissions, mainly of parts of the history. Sixteen of these 17 patients were treated by just two of the eight doctors.

Reasons cited for omission were fear of distressing the patient (14 instances), concern about people other than the patient having access to information (four instances), and protection of information supplied by third parties (two instances). General practitioners were informed of the omitted information, either by letter or in person.

Forty patients (55%) responded to the questionnaires. Most patients (33 out of 40) wished to continue receiving copies of correspondence.

Sending patients a copy of the letter to the general practitioner after a psychiatric consultation is valued and appreciated by patients; some doctors are, however, worried about distressing patients by what they write and consequently tend to omit information. Some training and reassurance about this practice may be needed before implementation.

Table.

Results of audit of psychiatrists' practice when copying letters to patients

No of cases
Letter sent to patient
Copy of general practitioner's letter 73
None 3
General practitioner's letter with at least one omission 17
Parts omitted
History or examination details 14
Diagnosis 3
Prognosis 6
Reason for omission
Fear of distressing patient 14
Other concerns 6
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References

  • 1.Department of Health. The NHS plan. London: Stationery Office; 2000. [Google Scholar]
  • 2.Working Group on Copying Letters to Patients. Copying letters to patients: a report to the Department of Health and draft good practice guidelines for consultation. Leeds: Department of Health; 2002. [Google Scholar]
  • 3.Eaton L. Patients should be sent copies of doctors' letters about them. BMJ. 2002;325:1056. doi: 10.1136/bmj.325.7372.1056/c. . (9 December.) [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4.Asch R, Price J, Hawks G. Psychiatric out-patients' reactions to summary letters of their consultations. Br J Med Psychol. 1991;64:3–9. doi: 10.1111/j.2044-8341.1991.tb01637.x. [DOI] [PubMed] [Google Scholar]
  • 5.Thomas P. Writing letters to patients. Psychiatr Bull. 1998;22:542–545. [Google Scholar]
BMJ. 2003 Feb 22;326(7386):449.

Copying letters can help avoid communications nightmare

Suzy Chapman 1

Editor—As the parents of a young person with myalgic encephalomyelitis/chronic fatigue syndrome who has regular appointments at paediatric outpatient clinics, we have received copies of all follow up letters to our son's general practitioner for over three years now.1-1

These have been provided as a matter of course, but we would have otherwise requested them. Copies of follow up letters are also copied to my son's educational welfare officer, school heads, and special educational needs coordinator, as appropriate.

We have also received copies of referral letters from his paediatric doctor to consultants and heads of other hospital departments, the local education authority in support of continuing provision of home tuition, and examination boards in support of “special arrangements” for GCSE examinations.

Occasionally, errors in letters have occurred, but we are in a position to pick up on these and have them corrected. Administrative errors have also occurred—I am told, through the use of temporary secretarial staff. This has resulted in follow up letters being sent to the wrong general practitioner at the wrong surgery and to an unnamed special educational needs coordinator at the wrong school, evidenced by the list of copied recipients at the foot of our copies of these letters.

For parents of young people who are unable to access mainstream education because of long term illnesses such as myalgic encephalomyelitis/chronic fatigue syndrome the difficulties in maintaining effective liaison between school, special educational needs coordinator, educational welfare officer, home tuition coordinator, general practitioner, hospital consultant, community paediatrician, and local education authority can be serious. In addition, some families also deal with social services and child and adolescent mental health services, as well as having input from the connections service.

For many it can be a communications nightmare on top of an already challenging situation. Anything that helps to improve liaison, such as receiving copies of hospital letters, is to be welcomed, and I would advise all parents to ask for copies of these letters if they do not already receive them.

References

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