Writing skills are given short shrift in medical school, but clinicians are given ample opportunity to develop such expertise once they start practising. Because of the increasing number of notes and letters I am called upon to produce, my writing has developed certain characteristics, including brevity and, if I may be so bold, flair. I have also developed a particular interest in writing fiction.
My provincial health plan requires a referral letter from a family doctor if a patient is to visit a specialist, but sometimes I wish I could be more truthful when I write them. If I was, my request for an orthopedic consultation might read: “Please see the patient's back. He is tired of paying his chiropractor.”
My truthful note to the plastic surgeon could read: “What are these funny bumps?”
My missive to the internist? “I have no idea what is wrong with this patient. Could you please see him and order lots of tests?”
I'm also very good at writing back-to-work notes, particularly because I don't think anyone takes the time to read them. Sometimes, I will collude with my patient and let my terrible handwriting deteriorate even further, until the note reads: “Flxmlb brolp flup, Yrs trly.” I wonder if providing the patient with part of my grocery list — “Three packs of gum, spaghetti, Yrs trly” — would make any difference?
Some of my patients think I am trapped in the past — one man asked me to write a note certifying that he had been ill 2 months before his visit. In another case, a mother wanted me to write that her child had not been to the daycare centre for 3 weeks because it was dirty. I wrote: “This child has not been to daycare for 3 weeks because her mother tells me the place is dirty.” I can't understand why she did not accept it.
I wrote this note for a patient who was having a difficult time because of her coworkers' nicotine habit: “Smoking is not good for you, Yrs truly.”
I often have to contemplate writing a letter to our Ministry of Health in order to request coverage for a certain drug. The pharmaceutical company has been most helpful, as it offers letter-writing assistance from an agency and even provides templates to which I only have to add my letterhead and signature. The letter uses absolutely clear and rational language to point out that the drug is essential to my patient's welfare and well-being. Some patients will never know how close they came to an adverse outcome without my help and writing ability.
And the note I'd most like to write for myself after another hard day? “Requires massage therapy, Yrs truly.”
Figure.
Photo by: Jeanne Simpson