Copying letters to patients
BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7376.1359 (Published 07 December 2002) Cite this as: BMJ 2002;325:1359
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As the parent of a young person with ME/CFS who has regular
appointments at paediatric outpatient clinics, we have received copies of
all follow up letters to our son's GP, for over three years now.
These have been provided as a matter of course, but we would have
otherwise requested them. Copies of follow up letters are also CCd to my
son's EWO, School Heads and SENCO, as appropriate.
We have also received copies of referral letters made by his paediatric
doctor to consultants and heads of other hospital departments, to the
Local Education Authority in support of continuing provision of home
tuition, and to 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 (due I am told to the use of temporary
secretarial staff). This has resulted in follow up letters being sent to
the wrong GP, at the wrong GP surgery, and to an unnamed SENCO, at the
wrong school, evidenced by the list of CCd recipients at the foot of our
copies of these letters.
For parents of young people who are unable to access mainstream
education due to long term illnesses such as ME/CFS there can be
significant difficulties maintaining effective liaison between school,
SENCO, EWO, GP, hospital consultant, community paediatrician, and LEA.
In addition, some families also deal with social services, CAMHS and have
input from the Connexions Service.
For many, it can be a communications nightmare on top of an already
challenging situation. Anything which helps to improve liaison such as
the receipt of 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.
Competing interests:
None declared
Competing interests: No competing interests
Fifteen years ago, I was telling the late Professor John Dennis about
a project I was running, which involved giving an audiotape of the clinic
'interview' to couples attending the fertility clinic. He expressed
interest, and told me that for some time he had been in the habit of
sending copies of clinic letters to his patients.
After evaluating the (successful) project, I decided that the most
practical way to help long term was indeed to adopt this policy for both
clinic and theatre events.
The benefits are multiple- it demonstrates an open approach, allows
patients to feel part of the decision-making process and forces one to use
good and plain English! In addition, there is an opportunity for further
consideration by the patient of her/his situation, with easy reference to
the facts and opinions stated.The patient has the opportunity to respond
if one has got things slightly wrong (which does happen), and there is a
particular usefulness after diagnostic day-case procedures when immediate
spoken post-operative feedback is highly likely to be forgotten.
Pregnant women are sent a copy for their hand-held notes,which offers a
safeguard should the hospital notes be missing or the woman be attending
an'out of area' hospital.
Plainly there will be times when sending copies may be unhelpful or even
deleterious. In my experience this is unusual.
I have found patients to be most appreciative of this approach, and can
recall only two occasions on which it was felt that I had made the
situation worse.In these days when at secondary care level we are doing
our level best to optimise 'one-stop' visits, such copy information
supplements one's communication skills and I believe, markedly reduces the
need for follow-up visits.
Competing interests:
None declared
Competing interests: No competing interests
Sir
I dictate all of my outpatient letters in front my patient at the end
of each consultation; this fulfils several roles: -
First it allows the patient to interrupt and correct any factual
errors I make whilst dictating. Also, by allowing him/her to contribute to
those details that he/she feels need emphasis, he/she maintains a sense of
involvement and this allows me to focus the consultation on the perceived
areas of importance.
Second, it allows closure the consultation, giving an oral synopsis
of the patient's current condition and planned treatment and is finalised
with the simple question: - ‘Did you understand all of that and have you
any further questions?'
I believe that this technique suffices well to inform most patients
of their disease and management. Should a copy of this letter later be
sent to the patient, he/she would already be familiar with its text and
terms and it would act beneficially to reinforce communication and draw
further the patient into the active management of his/her condition.
However, with limits on NHS funding, the provision of patients with these
letters must surely, above all others, be considered a non-essential,
optional extra service that not all patients want or need anyway. Those
that do should pay for it.
Competing interests:
None declared
Competing interests: No competing interests
Anyone who knows me will say that my clinical style is
open and demystifying. I talk straight to patients and
their families, and I want to do the same to their GPs. It
is simply naive to think that we can use the same kind
of candour in such different contexts. It is a logical error
to equate copying a letter between doctors with the
patient's right to information.
Competing interests:
None declared
Competing interests: No competing interests
Copying letters to patients-where is the funding?
Copying clinical letters to patients, an initiative set in place in
the NHS Plan 1, is due to be implemented throughout the NHS in April
2004.We have all been members of the Department of Health (DOH) Copying
Clinical Letters Working Group on the implementation of this policy, and
have contributed to several pilot studies that were set up to investigate
a range of issues raised by the working group.These included responding
to groups with special needs such as patients with visual , mental health
or learning difficulties and patients whose first language is not English,
as well as promotion of electronic access to computer based health
records.We feel that this is an important policy initiative supporting the
Government’s broad aim of improving communication and partnership between
patients and their clinicians. The Working Group report highlights
significant benefits to patients of copying letters including the
enhancing of trust, empowering patients to become more actively involved
in their health care, and improving the quality, accuracy, completeness
and readability of records 2.
However, many doctors & NHS Administrators have concerns about
how to implement this policy -education , training and resource needs have
been identified 3. The DOH has provided significant funding to explore how
best to deliver this initiative- we are therefore very concerned that
there is no funding identified to actually facilitate its implementation ,
either in terms of addressing specific issues raised in the pilot studies
or for training those who are going to write the letters that will be
copied to patients. There are also cost implications in administrative
terms for both primary and secondary care- as yet no guidance has been
received as to how hospitals and GP practices will fund this initiative.
We suggest the DOH addresses this issue with urgency to ensure that their
target implementation date of April 2004 is achieved.
References
1. Department of Health The NHS Plan for England. 2000.
2. Harris CB Copying letters to patients: Summaries of 12 pilot project
sites: www.doh.gov.uk/patientletters/pilots.htm, 2003.
3.Preparing professionals for partnership website
www.4ps.com/lettersharing
Competing interests:
All signatories were members of the Department of Health Copying Clinical Letters Working Group
Competing interests: No competing interests