The RCP's Health Informatics Unit (HIU) has partnered with the Professional Record Standards Body (PRSB) to develop standards for outpatient letters. Nick Lewis-Barned, an endocrinologist and diabetes specialist physician in Northumbria Healthcare NHS Foundation Trust, describes his experience of writing to patients.
Fifteen years ago, I’d have said letters are part of a dialogue with a fellow professional: a ‘technical’ response to an enquiry. Anyway, everything the person needs was discussed in our consultation. I know I would have said this because I did. I did not understand the rationale of copying my letters to patients; a colleague working in south Gloucestershire was writing letters directly to patients and it astounded me.
Since then, I have moved – not just geographically, also culturally. My view that people are grateful recipients of my skills has been challenged and I discovered that often patients actively (and continuously) manage their own health. Local GPs showed that local people valued being copied into letters and the NHS decided that people should almost always receive copies of letters. My trust implemented the change, and it became standard practice.
We asked some patients for their perspective. They said things like:
- ‘Of course I’d like to see what information is being shared about me’
- ‘Why wouldn’t you consider sharing that information with me?’
- ‘It’s my diabetes [or COPD or cirrhosis] anyway’
- ‘I’d be annoyed if my bank manager wrote to my mortgage provider, but not me’.
As a result, and from having this insight into the value of sharing this information with patients, I changed the way I wrote the letters, using simpler language, more closely reflecting conversations with the patients whilst in clinic. It seemed as easy just to write to the patient, and I often dictated the letter with the person still in the room.
GPs and other colleagues are happy, maybe happier, with letters that are now more person-centred and have less jargon.
What about my original concerns? With careful use of language, a bit of help from the patient, structured formats, and time to get used to it, it didn’t seem like a big deal. GPs and other colleagues are happy, maybe happier, with letters that are now more person-centred and have less jargon.
What do patients think? Just as I asked patients for their thoughts about why we should initiate the change, the best way to know what they actually think about it, now that the change has been made, would be to ask them again. No excuses. We buttonholed people after an appointment and the feedback was revealing. All had received letters, some sent to them and dictated while in the room.
Some of the comments included:
- ‘I feel like I matter … I’m not just a number’
- ‘warmer’ … ‘more relevant’
- ‘… something in black and white’
- ‘It helps to check that I understand’
- ‘[Listening in to the dictation] was a good summary … [and made it] easier to raise my bothers’.
Some now read previous letters before consultations.
Of course there are situations where writing to patients may be inappropriate; breaking bad news is always better face to face. But patients do not want any of the consultation withheld from letters.
So what next? Of course, we can always do better. People would like:
- quicker letter turnaround
- plans at the top rather than the end of letters
- use of bullet points and headings for clarity
- target ranges for results
- clearer use of language
- better explanations.
The search for the perfect letter goes on.
- You can also read our previous blog on outpatient letters: Dear Doctor – the importance of improving outpatient letters.
- Find out more about the work of the HIU by following @RCPLondon on Twitter and join the conversation using #healthinformatics.