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Copying letters to patients

Consultant Psychiatrist, Division of Psychiatry, East Wing 2nd floor, Homerton University Hospital, Homerton Row, London E9 6SR

The articles by Nandhra et al (Psychiatric Bulletin, February 2004, 28, 40-42) and Lloyd (Psychiatric Bulletin, February 2004, 28, 57-59) usefully discuss patients’ reactions to having copies of letters about them, but how widespread this practice is already might have been underestimated. For example, routine health insurance check-ups, as carried out by BUPA, usually result in a summarising letter to the patient.

However, it was disappointing not to see any attempt in these articles at equating the sending of letters with getting patients better from their illnesses. For example, while patients seem to like receiving the letter, which is not surprising, does this process improve compliance, does it reduce Did Not Attend rates, or does it reduce subsequent use of the Mental Health Act 1983 even in patients with severe psychosis? These would be useful questions to ask, because clinical effectiveness should surely be at the forefront of practice innovation.

There also seems to be little recognition of the secretarial burden. Not only are extra letters having to be posted and sent, but is it not more likely that the wrong information might reach the wrong patient, generating difficult complaints? Given the 20% turnover of general practitioner (GP) patients in inner London (indicating high degrees of transiency and address changing), this will be a particular problem in urban areas. How do we know who opens letters in people’s homes? Stigma, abuse and curiosity are unfortunately part and parcel of mental illness, while the problems of language and jargon, as well as the withholding of some aspects of information, may also cause complications.

Should all this not really be the province of the GP? It is the GP who initiates the consultation, and it would genuinely be a useful exercise for the GP’s referring letter to be copied to the patient - or even composed with the patient in the room - so that all relevant information was included. Given the quality of some GP referral letters, this in itself could enhance clinical communication. Likewise, given that the out-patient clinical letter is sent to the GP, why not let the GP discuss the letter with his/her patient, thus avoiding the risks of wrong addresses, mis-sent enclosures, unexplained jargon and omissions of information by clinicians concerned about confidentiality etc. It is after all meant to be a ‘primary care-led’ service, and GPs are much more likely to be aware of the broader social and family issues relevant to a particular patient’s capacity to understand and deal with health information.

This Article Full Text (PDF) Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Turner, T. Search for Related Content PubMed Articles by Turner, T.