Rheumatology Advance Access originally published online on December 13, 2005
Rheumatology 2006 45(4):493-494; doi:10.1093/rheumatology/kei229
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LETTER TO THE EDITOR |
Copying correspondence to patients
Selly Oak Hospital, University Hospitals Birmingham NHS Foundation Trust, Rheumatology, Birmingham, West Midlands, UK
Correspondence to: P. Jobanputra. E-mail: p.jobanputra{at}bham.ac.uk
SIR, We read with interest Nixon and Courtney's survey [1] about copying correspondence to patients. In our survey we asked patients their views using three open-ended questions rather than using a structured questionnaire. First, we asked what patients liked about receiving the letter that was written about them and sent to their GP; second, we asked what they did not like about receiving these letters; third, we asked what they would like changed about these letters. We also left space for other comments and asked patients to bear in mind that the letter was a communication between doctors. The choice of our questions was based on a study of patient satisfaction that we have used in surveys of our out-patient practice [2]. We surveyed 61 new patients and 141 follow-up patients seen in one consultant's clinic. Fourteen (23%) new patients and 79 (56%) follow-up patients responded. Responses were classified, independently, by two researchers and the classification later agreed by consensus.
All but one follow-up patient felt that copy letters were a good idea. The dissenting patient wanted letters written directly to them and did not want their GP to be kept informed. Reasons given for appreciating this practice are shown in Table 1.
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There were fewer responses to the question about dislikes (overall 65 patients, 70%). A majority (72%) felt nothing needed to be changed but two patients were concerned that this practice imposed a burden on the NHS. Overall five patients (5%) did not want sensitive information included and 5% had difficulty with medical terminology. Two follow-up patients had difficulty in accepting the reality of diagnoses listed in the letter. One comment in each of the following categories was received: inaccuracies in medical history; delayed receipt of letter; regret that other departments did not supply letters; and, did not wish GP to receive this information. In describing how letters could be improved patients referred to voiced dislikes; for example, recommending correction of errors or removing medical terminology. Others requested that results of investigations be added (four patients). One individual even expressed a concern that the content of letters was being edited for patients’ consumption. In the space for other comments four patients expressed their gratitude. One each requested that: the letter be sent in large print; the letter be translated into other languages; and the letter contain more information.
Our survey clearly indicates that most patients value copies of correspondence sent to their GP. Many use the letter to reflect on issues discussed in the consultation and seem to be empowered in terms of feeling involved, understanding the disease process and understanding the health professional's perspective. These are key aspects of care in chronic disease. It was disappointing that a small proportion of new patients responded, particularly as the first letter about a patient is an opportunity to touch on their key concerns. However, it is possible that in many cases the episode was incomplete and depended on results of investigations, perhaps inhibiting a response to our survey. We also did not pursue non-respondents with a second mailing.
Despite our best efforts, including the use of a structured out-patient letter that has sections for diagnosis, past medical history, medication and a section describing the consultation, many patients, including regular attenders, do not know important items of medical information, such as diagnosis. Also, despite a national mandate that patients receive a copy of their correspondence many of our hospital colleagues have resisted this practice. The reasons for this are unclear, but most focus on adequacy of resources as in Nixon and Courtney's survey. Our own anecdotal experience is that the imposed workload is trivial and that the advantages far outweigh workload; for example, we have commonly found that inaccuracies in medication lists or past history are highlighted by patients, and also that recommended drug changes are more likely to be implemented between appointments. We also believe that overall patient satisfaction is improved, thereby reducing the risk of ‘doctor shopping’ and duplicate investigation [2].
Many doctors dictate correspondence to GPs in patients’ earshot and perhaps also confirm that what is being said is acceptable. Others have used audio tapes. Both of these practices would need more resources, but it is unclear if these afford greater advantages. A difficulty with medical terminology was an important concern for patients. Our survey does not reveal whether other aspects of the language used in letters heals or harms patients [3]; some clearly felt that there was a mismatch between their experiences and the diagnoses listed. A personalized copy could be sent to patients and perhaps a separate copy to GPs [4]. This would clearly increase workload, though such practices may be justified if it were clear that outcomes could be improved. We concur with Nixon and Courtney that this practice should be embraced.
We would like to thank Sue Wycherley and Drs Ratna Rajaratnam and Rebecca Payne for their contributions to this work.
The authors have declared no conflicts of interest.
References
- Nixon J, Courtney P. Copying clinic letters to patients. Rheumatology 2005;44:255–6.
[Free Full Text] - Concato J, Feinstein AR. Asking patients what they like: overlooked attributes of patient satisfaction with primary care. Am J Med 1997;102:399–406.[CrossRef][Medline]
- Bedell S, Graboys TB, Bedell E, Lown B. Words that heal, words that harm. Arch Intern Med 2004;164:1365–8.
[Free Full Text] - Essex C. Copying letters to patients is coming to a clinic near you. Br Med J 2003;326:1330–1.
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