A randomised controlled trial of dictating the clinic letter in front of the patient

BMJ 1997; 314 doi: (Published 01 February 1997) Cite this as: BMJ 1997;314:347
  1. B W Lloyda, consultant paediatrician
  1. a North Middlesex Hospital, London N18 1QX
  1. Correspondence to: Dr B W Lloyd Children's Department, Royal Free Hospital, London NW3 2QG
  • Accepted 26 September 1996


For some years I have dictated clinic letters to the referring general practitioner in the presence of the family. This was originally to avoid the difficulties of dictating the letter later, but I have come to believe that families appreciate the opportunity to hear what I am writing to the general practitioner. I decided to evaluate this.

Methods and results

One hundred consecutive, newly referred outpatients were included in the study provided that they spoke English well enough not to need a link worker. Patients were assigned to either the study group or the control group at the end of the consultation. The assignment was made according to which of two closely similar questionnaires (identical except for the last question) I drew from a randomly shuffled folder of questionnaires (2).

Questionnaire given to parents participating in the study

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If a family was in the study group, I dictated my letter to the general practitioner in front of them. If the family was in the control group I dictated the letter after they had left the room.

Both groups were asked to fill out a questionnaire about “how we run the clinic” after leaving the consulting room. Its anonymity was emphasised. Apart from the last question of the questionnaire there was no clue that I was studying the way I dictated my letters. Data were analysed with χ2 testing.

No significant differences were found between the levels of satisfaction of the two groups in terms of the perceived clarity of my explanation, the perceived usefulness of the consultation, or my perceived honesty (table 1). No parent used any rating less favourable than “well”, “useful”, or “honest.”

Table 1

Numbers of parents in the two groups (n = 50, both groups) who rated the doctor and the consultation in different ways

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All 50 study families indicated that they liked me dictating the letter to their general practitioner in front of them. Five control families indicated that they would not have liked to hear the letter, and 11 families did not know whether they would have liked to hear it or not. The other 34 control parents indicated that they would have liked to hear me dictate the letter.


All parents who heard me dictate the letter reported that they liked hearing it dictated in front of them. Furthermore over two thirds of parents in the control group indicated that they would have liked to hear the letter dictated. Despite these findings, however, parents in the study group were no more satisfied with their consultations than those in the control group were.

I believe that what families like about the practice of dictating the letter in front of them is its openness. Further advantages include the opportunity for the parents to hear a formal summary of the consultation and the chance for them to correct the content of the letter. Letters written at the end of a consultation are likely to be more accurate and apt than letters written hours or days later. Partly because I write structured letters, few letters take more than two minutes to dictate.1

I have been unable to find any other studies of this matter. Rylance has shown that parents appreciate receiving tape recordings of outpatient consultations.2 Practical considerations (including cost) may have stopped this practice becoming widespread. Like many other doctors 3 4 I now send copies of clinic letters to almost all families that I see for the first time. Nevertheless, I continue to dictate letters in front of the family, and this study has shown that they appreciate it.


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View Abstract