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Views And Reviews Provocations

Bring outpatients into the 21st century

BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k2472 (Published 06 June 2018) Cite this as: BMJ 2018;361:k2472

A 21st century outpatient consultation should be followed by a letter written directly to the patient.

We agree entirely with Tessa Richards' lament about old fashioned outpatient clinics.

Her plea for the system to be redesigned in partnership with patients is in tune with an initiative of the Academy of Medical Royal Colleges. Called 'Please Write to Me', the Academy is producing guidance, approved by the Plain English Campaign, to support and encourage clinicians to write out-patient letters directly to the patient with a copy going to the GP.

This has been common practice in clinical genetics for many years [1] and others who have adopted the practice have overcome concerns about how to explain medical details clearly and accurately. Patients value these letters highly and GPs usually prefer them [2-4].

Writing letters directly to patients prompts doctors to rethink the way they carry out the consultation. Having to gather one’s thoughts to construct a letter that is readily understood, informative, and educational reinforces the role of the doctor as educator and helps focus the discussion on the issues that matter most to the patient [5]. The letters are also an opportunity to try out different ways of explaining the natural history of disease, risk, prognosis, and treatment to the patient and to other clinicians [6].

The time has come for doctors to put the out-patient at the centre of care by writing their letters directly to them. We are delighted that the Academy of Medical Royal Colleges is supporting and leading the way on this.

References:
1. Baker DL, Eash T, Schuette JL, Uhlmann WR. (2002). Guidelines for writing letters to patients. Journal of Genetic Counseling, 11(5), 399.
2. O’Reilly M, Cahill MR, Perry IJ. Writing to patients: a randomised controlled trial. Clinical Medicine 2006; 6: 178-82.
3. Jenny Taylor, Hugh Rayner, Steve Smith. Writing letters to patients. British Journal of Renal Medicine 2013; Vol 18 No 1 Supplement P21. http://www.wmrn.co.uk/assets/BJRM-Shared%20Decision%20Making.pdf
4. https://www.rcplondon.ac.uk/news/writing-letters-patients-what-s-big-deal
5. NHSE campaign ‘What matters to me’ https://www.england.nhs.uk/what-matters-to-you/join-in/
6. Trevena LJ, Davey HM, Barratt A, Butow P, Caldwell P. A systematic review on communicating with patients about evidence. Journal of Evaluation in Clinical Practice 2006; 12: 13-23. 


Competing interests: No competing interests

13 June 2018
Hugh Rayner
Consultant Nephrologist
Prof Nigel Mathers, Emeritus professor of Primary Medical Care, University of Sheffield. Robina Shah, Senior lecturer, University of Manchester, Chair UK Patients and Carers Partnership Group.
University Hospitals Birmingham NHS Foundation Trust
Birmingham Heartlands Hospital, B9 5SS