Intended for healthcare professionals

Practice Essentials

Writing outpatient letters to patients

BMJ 2020; 368 doi: (Published 27 January 2020) Cite this as: BMJ 2020;368:m24

Linked Opinion

Writing letters directly to patients puts them at the centre of their care

  1. Hugh Rayner, consultant nephrologist1,
  2. Martha Hickey, professor of obstetrics and gynaecology2,
  3. Ian Logan, clinical lecturer in nephrology3,
  4. Nigel Mathers, emeritus professor of primary medical care4,
  5. Peter Rees, chair of Academy of Medical Royal Colleges patient lay committee5,
  6. Robina Shah, senior lecturer in medical education and director of the Doubleday Centre for Patient Experience6
  1. 1University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  2. 2The Royal Women’s Hospital and the University of Melbourne, Victoria, Australia
  3. 3Freeman Hospital, Newcastle upon Tyne, UK
  4. 4University of Sheffield, Sheffield, UK
  5. 5Academy of Medical Royal Colleges, London, UK
  6. 6University of Manchester, Manchester, UK
  1. Correspondence to H Rayner hughrayner{at}

What you need to know

  • Most patients and general practitioners prefer outpatient letters to be written directly to patients

  • Ask patients’ permission before sending them printed letters; written consent is needed for letters via email

  • Consider patients’ best interests and whether the content could be harmful before writing directly to them

In many countries (including the UK and Australia) it is still common practice for hospital doctors to write letters to patients’ general practitioners (GPs) following outpatient consultations, and for patients to receive copies of these letters. However, our experience suggests that hospital doctors who have changed their practice to include writing letters directly to patients have more patient centred consultations and experience smoother handovers with other members of their multidisciplinary teams.1 Writing letters to patients is also being used as an educational tool for improving medical students’ empathy and rapport with patients.23

A large proportion of patient complaints and litigation originate from poor communication.4 Correspondence that is delayed, not patient centred, and lacking information has been highlighted as a risk to patient safety.5 Writing prompt letters directly to patients can help reduce these risks.6

In this article, we offer practical advice on how to construct letters to be sent directly to patients, and suggest how these letters might encourage collaborative working centred on patients’ needs and wishes.

Evidence on this topic is limited but includes a small number of quality improvement studies looking at the impact of clinic doctors writing letters directly to patients or to the parents of paediatric patients, and these have consistently shown positive outcomes.

Four of us—Hugh Rayner, Nigel Mathers, Peter Rees, and Robina Shah—contributed to the 2018 guidelines on writing outpatient letters to patients for the Academy of Medical Royal Colleges (AoMRC) in the UK.7 These guidelines were based on our personal …

View Full Text

Log in

Log in through your institution


* For online subscription