At the end of last year, the Academy of Medical Royal Colleges published guidance for doctors on best practice for writing to patients.

Here, Prof Nigel Mathers, Emeritus Professor of Primary Medical Care, University of Sheffield and Dr Hugh Rayner, Consultant Nephrologist at the University Hospitals Birmingham NHS Foundation Trust, explains how the guidance helps patients and saves time for doctors.

As the GMC’s Good medical practice sets out: ‘You must give patients the information they want or need to know in a way they can understand’. The Academy of Medical Royal Colleges (AoMRC) published in September last year important guidance that helps hospital doctors fulfill this fundamental requirement.

This guidance, endorsed as best practice by the AoMRC, aims to encourage doctors to write most of their outpatient clinic letters directly to patients and send a copy of the letter to the patient’s General Practitioner (GP). A team of hospital doctors, GPs and patients developed the guidance, which was edited and approved by the Plain English Campaign.

Speaking in support of the ‘Please Write to Me’ initiative, Peter Rees, Chair of the AoMRC’s Patient Committee said, “It’s high time this simple step was taken. Patients are generally far more informed about their health these days and it helps them take ownership of their care. It also helps patients remember what was discussed in the outpatient clinic and gives them confidence that the doctor sees them as a person rather than a case.”

Saving your time

With more than five million outpatient visits per month in England, outpatient clinic letters are the most-written letters in the NHS. The benefits of writing directly to the patient rather than sending them a copy of a letter written to their GP have long been recognised.[1] Both patients and GPs were very positive about letters written directly to patients in trials carried out in a haematology clinic and surgical unit.[2] Doctors who adopted the practice say their communication style has become more patient-centred.[3] GPs also find the letters easier to understand and spend less time interpreting the contents for their patient.

Most importantly, patients find such letters more informative, supportive and useful. Writing directly to the patient (or their parent/guardian) also helps avoid awkwardness caused by writing about them in the third person.

What patients say

The benefits of writing letters directly to patients are clear, judging by patients’ comments (see some of them below). They strengthen the doctor-patient relationship and help patients cope with their condition.

Appreciate the letter addressed to me.

I can now understand the treatment I am having for my illness and I’m happy to know that I’m making some progress along the way.

In addition, the letters serve as a handy reminder of important information as many patients struggle to remember things they were told during a consultation.

When you come home from outpatients, you have forgotten what the doctor has told you.

I for one will have forgotten half of what you have told me by the time I get home.”

The patient may also want to share the letter with their relatives and carers and discuss its contents. They provide useful continuity between clinicians and anyone else involved with the patient’s condition.

Good to keep the letter, if you are under different consultants you can just show them the letter instead of explaining every time.

Keeps me informed and can update people at work with my progress when they ask.

Patients can use them as records of visits which show what medications they are on, investigations/tests discussed.”

Patients can also let clinicians know about any errors and alert them to changes made by other doctors.

Wrong post code. Two medications to be added to list.

My GP has changed the Pravastatin to Simvastatin.

The letter can include test results and confirms that the doctor has seen them.

As blood was taken it would be very useful to know the results. If my appointments are at two-monthly intervals my knowledge of my current state is always two months out of date as I do not see results until my next appointment.

Three key aims

The AoMRC guidance explains how to achieve three key aims of an outpatient letter.

  • record relevant facts about the patient’s health and wellbeing
  • present information in a way that improves understanding
  • communicate a management plan to the patient and GP.

Using examples and clear explanations, it sets out the structure, content, style and grammar to adopt when writing letters, and explains how to address concerns about consent and confidentiality.

The Academy encourages Medical Schools, Royal Colleges and Specialist Societies to produce their own specific guidance. The guidance can be included in undergraduate and post-graduate teaching materials and used when assessing written communication skills.

[1] Baker DL, Eash T, Schuette JL, Uhlmann WR. Guidelines for writing letters to patients. Journal of Genetic Counseling 2002; 11(5): 399

[2] O’Reilly M, Cahill MR, Perry IJ. Writing to patients: a randomised controlled trial. Clinical Medicine 2006; 6: 178-82; Mahadavan L, Bird NJ, Chadwick M, Daniels IR. Prospective assessment of patient directed outpatient communication from a patient and general practitioner perspective. Postgrad Med J. 2009 Aug;85(1006):395-8.

[3] Taylor J, Rayner H, Smith S. Writing letters to patients. British Journal of Renal Medicine 2013; Vol 18 No 1 Supplement P21