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Letters to patients: sending the right message

BMJ 2002; 324 doi: (Published 16 March 2002) Cite this as: BMJ 2002;324:685
  1. Philip E M Smith (, consultant neurologist
  1. Welsh Epilepsy Unit, University Hospital of Wales, Cardiff

    Ihad described her in my letter as “enmeshed with her mother,” although I had kept this opinion to myself during the consultation. It was a trivial and unnecessary remark, which added nothing to the diagnosis or management plan. Her general practitioner, embarrassed for me, refused her mother's request for a copy of the letter. Eventually, of course, she obtained one and was understandably annoyed by the attempted cover up. My throwaway line had damaged my relationship with the patient, but more importantly had strained the trust between her GP and the family. I resolved then that my clinic letters would report the consultation solely, would include only narrative and comments openly discussed, and would be copied to the patient.

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