Intended for healthcare professionals

Letters Copying letters to patients

Copying patients in is not as simple as it seems

BMJ 2008; 337 doi: (Published 10 December 2008) Cite this as: BMJ 2008;337:a2687
  1. Brian McKinstry, reader1
  1. 1Primary Care Research, Division of Community Health Sciences: General Practice Section, University of Edinburgh, Edinburgh EH8 9DR
  1. brian.mckinstry{at}

    Richards advocates copying patients into all correspondence on the grounds of improving health literacy,1 but a sizeable minority of people in the UK have general literacy problems and are unlikely to benefit.2

    As currently written, many letters from hospitals are difficult for patients to understand. My colleagues and I have had to explain to alarmed and bewildered patients who have received copies of their correspondence the meaning of phrases such as “the benefits of IOL may be limited because of the presence of incurable dry AMD [translation at the bottom of the letter].” It is not difficult to see why patients with several chronic conditions may erroneously interpret such information in the worst possible way, or even as a terminal prognosis.

    Some patients will not want confidential details of their medical history entrusted to the postal service, or the risk that they might be viewed by other family members. Patients would have to be informed about the potential for data loss once the letter leaves the NHS and should be asked to give consent. It cannot be routine. This of course will add to the length of any consultation.

    Our practice sends and receives several hundred letters and investigation results every day. Who will pay even a conservative estimate of £0.5 ($0.75, €0.6) per item for copying patients into correspondence? Hospitals and practices will have to stop some services they currently provide to pay for it. How will we know if the intervention is cost effective? Access to an electronic record (for the computer literate) would reduce the cost but has its own drawbacks.3

    Before rushing to provide the service that Richards suggests, we must think it through, plan it properly to maximise its benefits to all patients, and decide whether the potential overall benefit is worth the cost.


    Cite this as: BMJ 2008;337:a2687


    • IOL=intraocular lens replacement, AMD=age related macular degeneration.

    • Competing interests: None declared.


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