Okay, imagine this. You get a letter from your
doctor and well, instead of this dense jargon
filled thing that seems written for, I don't
know, someone else entirely. You actually understand
it. Everything. Your diagnosis, why they did
certain tests, what the treatment really involves,
and crucially, what happens next. Right. That
moment of clarity. Exactly. That moment where
you finally grasp your own health story. That's
really what this deep dive is all about today.
We've seen how powerful this can be. Patients...
talking about finally understanding a diagnosis,
maybe years after it was first mentioned, just
by reading their notes. It's quite shocking when
you hear that, isn't it? It really is. And yet
we also know from research that, well, a lot
of clinical letters just aren't that easy for
patients to read. No, the evidence points that
way. So that highlights a critical gap, doesn't
it? A sort of fundamental challenge in how we
communicate health care information today. So
today we are taking a deep dive right into that
gap. We're unpacking the whole world of clinical
correspondence, focusing specifically on the
guidance, the movement towards writing letters
to patients, or at least making sure the letters
patients get are clear and understandable for
them. We've gathered quite a stack of sources
for this, you know, important guidance from key
players like NHS England, the Academy of Medical
Royal Colleges, and specific groups like the
Royal College of Psychiatrists, the Radiologists
too. Yes, quite comprehensive guidance is emerging.
And, crucially, we'll be looking at insights
from a service evaluation study gives us a real
snapshot of current practice and, importantly,
the barriers clinicians actually face in making
this shift happen. But you're very real barriers.
Definitely. So our mission is to distill what
these sources say is needed, why it matters so
much, and, well, how it might actually be achieved
in practice. OK. And to guide us through all
this material, help us make sense of it, we have
an expert with us who can synthesize all this
guidance and really shed light on the practical
side. Welcome. Thank you. It's a really vital
area, this, so I'm very pleased to be discussing
it. It really feels like sort of a pivotal moment
in health care communication, doesn't it? I think
it does, yes. So let's dive straight in. The
sources, they make it pretty clear. This isn't
just a suggestion anymore or a nice to have.
There's a real powerful drive towards making
sure patients get these letters and can actually
understand them. What's the... The fundamental
principle behind this shift, where is this imperative
coming from? Well, fundamentally, it's rooted
right in the ethical and professional duties
that clinicians have. If you look at, say, the
General Medical Council's good medical practice,
the core principle is stated very clearly. Clinicians...
must give patients the information they want
or need to know in a way they can understand.
Right. That seems pretty unambiguous. It is.
And it's not exactly a new idea, but how we put
it into practice is definitely evolving, giving
patients a clear, understandable copy of their
clinic letter that's a direct, tangible way to
meet that obligation. OK. It moves things beyond
just, you know, telling the patient something
during what might be quite a rush of consultation.
Which often happens. Indeed. It provides a written
record they can actually go back to, digest in
their own time. So it's really about transparency,
then, and making sure information isn't just
lost once you walk out the door. Precisely. And
it's all part of this much broader move towards
genuinely patient -centered care. Historically,
as you mentioned right at the start, these letters
were mainly, well, doctor -to -doctor communication,
weren't they? Yeah, like a handover note. Exactly,
a handover, a record for the file. But the whole
landscape has shifted. Patients now, quite rightly,
expect to be partners in their own health care.
And this is reflected in the guidance coming
from bodies like the Academy of Medical Royal
Colleges. Their Please Write to Me campaign was
really significant. Ah, yes, I remember that.
And the Professional Records Standards Body,
the PRSB, they also set standards for the structure
and content of electronic health records, including
these letters, specifically with patient access
in mind. Even nice guidance often talks about
clear communication and shared decision -making.
Which needs accessible information. Exactly.
You can't have shared decisions without shared
understanding. So these bodies, they aren't just
recommending this anymore. They're setting clear
expectations. Standards that say providing understandable
letters directly to patients is becoming the
norm, you know, not the exception. So the expectation
has changed. It has. It's shifting the primary
purpose of the letter. It's still for professional
communication, still for the record, but now
it has this added crucial purpose of patient
empowerment. That framing, shifting from a doctor
to doctor record to a patient empowerment tool,
that's really powerful, isn't it? I think so,
yes. And the sources really hammer home why this
matters by highlighting the actual benefits patients
see. What do they tell us of the sort of concrete
advantages? Well, the benefits that are detailed
are quite significant, and they cover several
areas. The most obvious one is just better patient
understanding. Understanding their diagnosis,
the overall care plan, the reasons behind treatment
decisions. Makes sense. Think about a consultationship.
It can be quite overwhelming, can't it? Patients
might only take in a fraction of what's said,
especially if it's complex medical stuff. A clear
letter gives them a permanent record they can
read, reread, maybe share with family. At their
own pace. Exactly, at their own pace. And they
can clarify things. This increased understanding,
it fosters a sense of involvement, of control
over their own health, which is absolutely fundamental
to a patient -centered approach. Right. But it
goes deeper than just understanding. The sources
give some really quite stark examples that underline
the consequences when this communication doesn't
happen well. Oh, like what? Well, cases where
patients discovered really significant diagnoses,
things like post -traumatic stress disorder,
PTSD, or emotionally unstable personality disorder.
EUPD, years after these, were initially made
by specialists. Years later, how did they find
out? They only found out by accessing their old
clinical records. You know, going through them
painstakingly records that were never clearly
communicated or explained to them at the time.
Wow, years later. Well, that's staggering. What
kind of impact does finding out like that have?
Oh, the impact is profound. It means years. potentially
lost, years where the patient didn't understand
their own condition, didn't have the chance to
fully engage with treatment or seek the right
support for that diagnosis. You can imagine.
It can lead to delayed treatment, massive misunderstandings
about their own experiences, and significantly,
it just erodes trust in the whole health care
system. Of course. If you discover a major diagnosis
about yourself sort of hidden away in records
you weren't meant to read or couldn't understand
if you did, it just creates this huge barrier
for the future. Yeah, it sends a terrible message.
It sends a message that you weren't seen as a
key partner in your own care. And the sources
use these examples very explicitly to say. This
is precisely why clear, patient -directed communication
in letters isn't just good practice. It's essential
for ethical care. It's essential for effective
treatment. And it's essential for building trusting
relationships with patients. So the stakes are
incredibly high then. It's not just about administrative
tidiness. It's right at the heart of patient
outcomes and trust. Absolutely. OK, so let's
shift gears a bit from the why to the how. If
you're sitting down to write a letter with the
patient really in mind, what are the core components
that need to be in there, according to this guidance.
Okay, well first, it's probably crucial to clarify
something. Well, one common way of doing this
is to send the patient a copy of the GP letter.
Right, the Carver copy approach. Yes. The guidance
really emphasizes that the letter must be written
with the patient being a primary intended reader.
This might mean tailoring the language, maybe
even structuring it slightly differently than
you would for purely doctor -to -doctor communication.
So it's not just hitting copy? Ideally not, no.
or at least writing the original, knowing the
patient will read it. The letter serves multiple
purposes, multiple readers, the team, the GP,
the patient. But its effectiveness for the patient
has to be paramount if they're receiving it.
OK, got it. So what information is essential?
Well, the guidance across the various sources
is actually pretty consistent on the essential
information. It starts with the basics, clear
patient details, their GP practice details. Then
it moves into the medical specifics, but presented
clearly. So the diagnosis, or if it's not firm
yet, the suspected diagnosis and how you're going
to clarify it. Right. Crucially, known allergies
must be stated very clearly. Any medication changes
made during or after the appointment need to
be detailed. Then there's a really critical section
outlining Actions. Actions. Yes. Clear instructions
or tasks for different people. So, actions for
the GP, actions for maybe the hospital clinician,
and really importantly, actions for the patient
themselves. Ah, the actions for the patient bit.
That seems absolutely vital for clarity, doesn't
it? It really is. It helps the patient understand
exactly what they need to do next. Is it picking
up a prescription, scheduling a follow -up, making
a lifestyle change, monitoring symptoms? It needs
to be spelled out. Okay. Alongside those actions,
the letter should have a concise summary of the
appointment itself. Key examination findings,
test results discussed. And finally, clear information
on the next steps. What's the overall plan? When
and how will follow -up happen? And who should
they contact if they have questions or problems
down the line? That sounds quite comprehensive.
It is. And the PRSB, which we mentioned, has
been really helpful in standardizing headings
for these outpatient letters. Mandatory headings,
recommended headings to help clinicians structure
all this information logically. That makes it
easier for everyone, including the patient, to
find what they need quickly. Highlighting that
action section, maybe in bold or near the top,
is also specifically recommended in some guidance.
So clear structure, all the necessary facts.
But the real sticking point, and something the
research you mentioned highlighted, is the language
itself, isn't it? The jargon barrier. How did
the sources tackle that? Yes. This is arguably
the most significant point. And it's hammered
home consistently across all the guidance documents.
The mandate is completely unambiguous. Use plain
English. Simple. well, simple to say, avoid medical
jargon and abbreviations wherever you possibly
can. Now, that's much harder to do consistently
when you're immersed in medical terminology day
in, day out. I can imagine. So the guidance stresses
that if you absolutely must use a medical term
or an acronym, maybe there's no simple alternative,
or it's essential for clarity with other professionals
reading the letter, then you must explain it
immediately and clearly. In plain language, for
the patient. Can you do an example? Sure. So
instead of just writing, say, ECG showed AF,
you write something more like the heart trace,
which is called an ECG, and measures the electrical
activity of your heart, showed that your heart
rhythm was irregular. This is called atrial fibrillation,
or AF, for short. Oh, OK. So you explain the
test, the term, and the acronym. Exactly. You
unpack it. The Royal College of Psychiatrists'
guidance. is particularly good on this, actually,
giving loads of examples of how to simplify quite
complex psychiatric concepts. Another specific
instruction mentioned is using the common English
names for medicines, not the Latin ones, which
can be, well, totally incomprehensible to patients.
It's about constantly asking yourself that question.
If I got this letter without my medical training,
would I understand every single word, every phrase?
That's a really good test to apply, isn't it?
And I think the sources even mention specific
tools that can help with this. They do, yes.
The Academy of Medical Royal College's guidance
and also that service evaluation study we talked
about, they explicitly mention using readability
tools. The Flesh Readability Score is the main
one mentioned. Flesh Score? How does that work?
It's basically a formula. It looks at average
sentence length and the average number of syllables
per word in a piece of text. It then calculates
a score, usually out of 100. Higher scores mean
easier readability. It often corresponds to a
U .S. school grade level, so a score of, say,
60, 70, is generally considered easily understandable
by an average 13, 15 -year -old, which is often
used as a benchmark for public information. Okay.
And the study used this? Yes. The service evaluation
actually applied this flesh score to a sample
of real clinical letters. And they found that
a high percentage scored quite poorly on readability.
So there's actual objective data showing the
problem exists in practice. What does a poor
score like that actually mean for a patient reading
the letter? What means exactly what those patient
quotes we discussed earlier illustrate it means
difficulty understanding Needing to look things
up. Maybe misunderstanding crucial information
about their condition or their treatment plan,
right? It creates barriers Exactly a letter that
scores poorly on the flesh test is highly likely
to have too much jargon Sentences that are too
long and convoluted and probably poor structure,
too This directly undermines those goals of patient
empowerment and shared understanding we talked
about. Yeah. It really reinforces the need for
clinicians to be incredibly mindful of their
writing style and maybe even to use these tools
sometimes as a check or perhaps for training
and feedback. It makes that abstract goal of
plain English much more concrete and measurable,
doesn't it? It does. It moves it from just subjective
feedback. This was hard to read to objective
data. The score is 45 on flash. That's really
interesting. Precisely. And it underscores that
while the principles are clear, actually implementing
them takes real effort and attention to detail.
Absolutely. Now, health care isn't one size fits
all, obviously, and patients are incredibly diverse.
The sources also spend quite a bit of time talking
about tailoring these letters for specific needs
in different clinical areas. How does the guidance
handle that complexity? Yes. This is where the
picture gets more nuanced. It's particularly
highlighted in the Royal College of Psychiatrists'
guidance, actually. While those fundamental principles,
clarity, plain language, essential content they
apply across the board, the way you present the
information and the specific details you might
include or emphasize absolutely must be adapted.
Tailored to the individual. To the individual
patient, yes. Their condition, their age, their
specific circumstances. A rigid, templated approach
just won't work without that flexibility. You
really need to think. Who is receiving this letter
and what do they need from it? Okay, let's break
down some of the specific examples given in the
sources What about say older people? What are
the considerations there for older people the
guidance points to specific things like potential
cognitive impairment or memory difficulties?
sending a very complex letter or One containing
a difficult diagnosis that perhaps the patient
doesn't fully recall discussing in the clinic
that could be quite distressing Exactly distressing
or just confusing So the guidance recommends
actually checking with the patient first. Do
they want to receive a letter? Particularly if
maybe previous letters haven't been well received
or caused upset. Right. Ask first. Yes. And in
some situations, and this needs really careful
thought and discussion with the patient, making
sure it's in their best interest and respects
their wishes as much as possible, it might be
more appropriate for the letter to go to a nominated
carer or a family member. To ensure the information
gets to someone who can support them. Precisely.
to ensure crucial information is available to
those supporting them. It's a delicate balance,
isn't it? Sharing information effectively while
respecting the patient's autonomy and avoiding
causing unnecessary distress. It sounds like
it. And what about for children and adolescents?
That seems like a completely different challenge
again. Oh, it absolutely is. The approach in
Child and Adolescent Mental Health Services,
CAMHS, which is detailed in the psychiatric guidance,
needs to be incredibly flexible. It has to respond
to the child's developmental stage, their capacity
to understand. For younger children, obviously,
a traditional detailed clinic letter addressed
to them just isn't appropriate. No. So you might
send a much simpler letter directly to the child,
maybe using very simple language, large font,
perhaps even pictures or symbols. Ah, interesting.
Focusing on key positive messages or actions
relevant to them, like remember to try that breathing
exercise we talked about. And then at the same
time, a more detailed letter With all the clinical
information, we'd go to the parents or guardians.
Okay, so two versions potentially. Potentially,
yes. And as adolescents get older, as their capacity
to understand and make decisions increases, the
communication has to adapt again. For older competent
teenagers, you might need to tailor the letter
primarily to them. Maybe even send it only to
them, depending on confidentiality considerations
and their wishes. Much like you would for an
adult. Right, respecting their growing autonomy.
Exactly. The guidance also mentions using tools
during the consultation for children. Things
like crib sheets with pictures or symbols that
explain key concepts or plans visually. They
can then take that home, so it supplements the
formal letter that goes to the GP and appropriate
family members. So thinking beyond just the traditional
letter format as well, perhaps using other tools?
Exactly that. It's about using all the communication
tools you have available and tailoring them to
your audience. And in CMHS, that means recognizing
you often have multiple audiences with very different
needs. Makes sense. And the guidance touches
on nuances in other areas, too. For instance,
in eating disorder services, the letter content
will likely need to include specific numbers
that might be sensitive but are clinically vital.
current weight, height, BMI, progress towards
target weight, that sort of thing. Liaison psychiatry
leaders often need to explicitly link mental
health issues to physical health conditions that
might be underlying or co -occurring. Forensic
psychiatry leaders have to include summaries
of relevant forensic history, details of legal
status, like detention under the Mental Health
Act, which needs very specific, careful phrasing.
Right, very specific requirements there. Yes,
and in oncology there are already established
templates for things like treatment summaries.
These need to detail complex chemo or radiotherapy
plans, and really critically, provide crystal
clear instructions on how to manage potential
side effects. The complexity there and the potential
seriousness of side effects just demands exceptional
clarity and accessibility. That really highlights
how specific the content needs can be in different
specialties. Sticking with the psychiatric guidance
for a moment, which seems particularly detailed
on this, there's a strong focus on handling sensitive
information and maybe potential disagreements
very carefully in the letter. Could you give
us a bit more insight into that aspect? Yes,
this is a really crucial and quite subtle aspect
of writing letters that patients will actually
read, especially in psychiatry. The language
used to describe someone's internal experiences,
their behavior, it can be highly charged, can't
it? Absolutely. The letter is a formal record.
And if it uses language that feels judgmental
or dismissive or just inaccurate from the patient's
viewpoint, it can be incredibly damaging, damaging
to trust, damaging to the therapeutic relationship.
So how does the guidance suggest phrasing things?
It gives specific practical examples. One key
area is how you talk about a patient's perspective
when it differs from the clinical view. The guidance
strongly advises against using phrases like the
patient having no insight into their condition.
Why is that? because it sounds like a definitive,
negative judgment on the patient. Instead, it
suggests a more descriptive, more respectful
approach that acknowledges both perspectives
are present. The example given is excellent,
I think. Instead of writing, patient has no insight
into schizophrenia. You could write something
like, I explained that my view is that these
experiences are part of an illness called paranoid
schizophrenia, and you disagree with this view.
You do, however, agree that you are not currently
feeling very well, and you are willing to follow
the plan we discussed below. Ah, I see the difference.
It acknowledges the clinician's view, states
the patient's disagreement factually, but then
finds calming ground on the plan. Exactly. It's
objective reporting of a difference in perspective,
rather than a loaded judgment about the patient's
insight. It validates their stated position while
still getting the clinical formulation across
for other professionals. That's a really tangible
difference in phrasing, isn't it? Much more respectful.
It is. Another example they give is avoiding
the word deny, particularly when reporting what
a patient says about potentially stigmatizing
behavior like maybe substance use. Why avoid
deny? Because saying a patient denied taking
drugs carries this subtle implication that you,
the clinician, believe they're taking them and
are being untruthful. Right. It sounds accusatory.
It can do. So the guidance recommends replacing
it with just objective reporting of what the
patient said. So instead of patient denied taking
illicit substances, you'd simply write, Patient
reports not taking any illicit substances. It's
a small change, but it removes that implied judgment.
It does. It just reports the patient's statement.
The example of Mrs. Pointer is another great
illustration of this sensitive reporting. She's
described as a patient with dementia who has
fixed beliefs about her neighbors entering her
house. Okay. The letter to her needed to communicate
the clinical understanding of this, but without
being confrontational or just dismissing her
lived experience, which is very real to her.
Very. The guidance suggests phrasing it carefully.
The letter explicitly states the doctor's view
that these experiences are likely related to
your memory problems, and it uses the clinical
terms delusions and hallucinations. But it immediately
balances this by adding something like, you are
clear that your neighbors are making the noises
in your house, and you did not agree with my
suggestion that these experiences might be linked
to your memory problems. So again, presenting
both sides. Precisely. presenting the clinical
interpretation and the patient's strongly held
differing perspective. It demonstrates respect
while still maintaining the necessary clinical
record. It sounds that the underlying principle
is report the facts, report the differing perspectives
neutrally, don't embed clinical judgment in a
way that feels invalidating to the person reading
it. That's a very good summary of it, yes. What
about including something like the mental state
examination, the MSE? That must feel quite clinical,
maybe a bit odd for a patient to read about themselves.
Yes, the mental state examination is, you know,
a standard part of any psychiatric assessment.
So it's a necessary component of the clinical
letter for professional communication. But you're
right, reading a description of your own appearance,
your mood, your thoughts, your perceptions, all
in clinical language, they can feel very strange
indeed for a patient. I can imagine. How does
the guidance suggest handling that? It acknowledges
it directly. They suggest handling it by actually
explaining what the MSE is for right there in
the letter to the patient. Ah, explaining its
purpose. Yes. The example phrasing suggests describing
it as something like a brief description of how
you seemed during the appointment in terms of
your appearance and how you were thinking and
feeling. And then crucially, they suggest adding
context, like this might seem strange to read,
but these snapshots are useful in keeping track
of how you were doing over time. OK, so it frames
it. It frames it. It preempts the patient's likely
reaction. Why are they writing about how I looked?
And frames that section not as some sort of clinical
dissection of them, but as a useful tool. for
tracking their progress, their journey. It makes
it feel less alienating, hopefully. That makes
sense. It's about providing context and purpose
for potentially confusing clinical stuff. Exactly.
It really highlights that every single part of
the letter needs thinking about from the patient's
viewpoint, doesn't it? It really does. We've
touched on the patient perspective quite a few
times, but let's dive a bit deeper into the actual
experience of receiving and reading these letters
as described in the sources. What did they find?
Well, The patient quotes included in some of
the source documents are incredibly insightful,
I think, because they capture the real emotional
weight these letters can carry. Right. It's not
just about transferring information. It's about
encountering this formal written description
of yourself and your health challenges. Yeah.
As one patient apparently said, reading their
notes made me realize the reality of my mental
health. So for some, it brings a difficult truth
into much sharper focus. A moment of reckoning,
perhaps? Perhaps. For others, the experience
can be quite uncomfortable. One quote was, read
the notes and cringe. Sometimes I didn't even
recognize the person, would just rip it up. Wow.
That really underscores that the language, the
tone, the content, they aren't just academic
points, are they? They have a real tangible emotional
impact on the reader. A poorly written letter.
even if it's factually correct from a clinical
standpoint, could be quite distressing, maybe
even triggering for some people. Definitely.
But conversely, a clear, sensitive letter can
provide immense relief and validation. It reinforces
the information discussed in the consultation,
which, as we said, can easily be partially forgotten
or misunderstood in the moment. Gives you something
concrete? Yes. It lets patients process information
at their own speed, on their own terms. It helps
move them from being just a passive recipient
of care towards being a more active participant.
And accuracy seems absolutely fundamental here.
Not just clinical accuracy for the record, but
factual accuracy from the patient's perspective
as a way to build trust. Precisely. The guidance
explicitly links giving patients access to their
letters with the opportunity for them to check
for factual accuracy. Now, this isn't really
about debating clinical opinions necessarily.
More about the facts. More about ensuring dates
are right. Symptoms are described as the patient
actually reported them. The plan reflects what
was agreed in the room. One patient quote, highlights
this perfectly describing how they and their
husband read a letter and had. a matter of interpretation.
Ah, interesting. It points to the fact that even
with clear communication, different people can
take different meanings from the same words,
can't they? Especially if it's complex or describes
subjective experiences. Very true. So giving
patients the chance to say, actually, that wasn't
quite what I meant or hang on, this data is wrong,
that strengthens the relationship. It shows the
clinician values, their perspective is committed
to getting an accurate shared understanding.
It shifts the dynamic, doesn't it? How so? Well,
it shifts it from one where the clinician is
the sole owner of the truth recorded in the letter
to one where the patient is actually a partner
in making sure the record reflects their experience
accurately. A partner in accuracy. I like that.
And how can clinicians actively encourage that
feedback loop and maybe use it to improve? Well,
the guidance recommends actively inviting feedback
on the letters themselves, both from patients
and also from other clinicians who receive them.
like the GP. Okay. This is framed as a really
crucial step for continuous quality improvement,
improving communication skills. For a clinician,
adapting their letter writing practice, maybe
trying out new templates, really focusing on
plain language that can be a powerful quality
improvement project. Right, something tangible
for appraisal. Exactly. seeking structured feedback
from patients. You know, was this letter clear?
Did it help you understand your condition and
plan? What could we improve? And also from colleagues,
was the relevant information easy to find? Was
the terminology clear? It provides concrete data,
data for reflection, for development. Makes sense.
And the sources do mention that this whole process,
reflecting on and improving communication, including
letter writing, can and absolutely should be
included in clinicians' professional appraisal
portfolios. It links this vital skill directly
to professional accountability and growth. So
it's not just some abstract ideal floating out
there. There are concrete mechanisms within professional
development frameworks to actually encourage
this. That's right. OK. We've talked a lot about
the what and the why and how ideally this should
all work. But that service evaluation study you
mentioned also looked at the reality on the ground.
you know, the barriers clinicians actually face
in implementing this shift towards writing patient
-friendly letters. What did that study find?
What are the hurdles? Yes, that evaluation provided
some really valuable practical insights. It surveyed
clinicians to understand what was stopping them
or making it difficult to consistently write
letters with the patient as a primary audience
or to tailor their existing letters appropriately.
And what came back? Well, perhaps unsurprisingly,
it showed that practice is still quite variable.
Many of the letters they actually reviewed were
still primarily written for the GP. And as we
discussed earlier with the readability scores,
they often weren't that easy for a layperson
to understand. Okay. So what were the barriers
clinicians mentioned? They were quite varied.
Some clinicians indicated a perceived lack of
need for change. You know, what we do now is
fine. Or maybe just a lack of awareness that
writing for the patient was actually the recommended
standard now. Right. Lack of awareness. Resources
were also mentioned things like access to specific
software features, maybe templates or dedicated
training time. But of a very significant barrier
reported by a really high percentage of clinicians
was simply time constraints. Ah, time, the perennial
issue in health care. Always. The perception
was... quite clearly that tailoring a letter
specifically for a patient simplifying the language,
maybe using a different template, would just
take significantly longer than their established
process, which is often dictating a standard
letter aimed mainly at the GP. Right. Dictating
the usual letter is quicker. So are there practical
strategies suggested in the guidance or other
sources to help clinicians overcome these, well,
very real time and resource barriers? Yes, thankfully
the guidance does offer some pragmatic solutions.
One key strategy that comes up repeatedly is
the use of available templates. Pre -made structures.
Exactly. Bodies like the PRSB, the Royal College
of Radiologists, McMillan Cancer Support. They've
already developed templates for outpatient letters
for treatment summaries that incorporate the
recommended structure, the right headings, including
things like actions for patient. Using these
predefined templates can significantly cut down
the time needed to structure the letter and helps
ensure all the essential bits are included consistently.
So don't reinvent the wheel every time. Precisely.
Use the tools that are already designed with
these principles built in. Makes sense. What
else? For clinicians who dictate their letters,
the RCR guidance specifically mentions improving
dictation as a skill itself. This involves speaking
clearly, structuring the dictation logically
following the desired letter endings, and, crucially,
working closely with administrative staff, with
secretaries. How does that help? Well, working
with them on using predefined styles or templates
within the dictation system or the electronic
health record software. Training for both clinicians
and secretaries on efficient, patient -aware
dictation and transcription that can streamline
the whole process considerably. It makes it more
of a team effort. They're leveraging administrative
expertise to support the clinical goal. Okay,
using the whole team. Yes. And there are also
some crucial practical points about the medium
of communication. The guidance is very clear.
You must get consent for the patient before sending
letters electronically. Obvious reasons, privacy,
security. Absolutely critical. And perhaps most
importantly, and this is reiterated very strongly
across the sources, it's a fundamental ethical
point. A letter should never be the first time
a patient receives upsetting or difficult news.
Never break bad news in a letter. Absolutely
not. That includes diagnoses of serious illness,
significant changes in prognosis, informing a
patient about a major adverse event. That always
requires a sensitive, direct conversation face
-to -face ideally, or maybe a planned phone call.
The letter's role is to summarize and reinforce
information that's already been discussed verbally.
Right, it supports the conversation. It supports
the conversation. It must never replace the difficult
parts of it. That's about managing patient expectations
properly and avoiding causing significant distress
through what can feel like very impersonal written
communication. That ethical constraint is so,
so important to remember, isn't it? And framing
this whole shift as a quality improvement activity,
as you mentioned earlier, that seems like quite
a clever way to integrate it into a clinician's
existing workflow and priorities, perhaps. I
think it provides a really useful framework for
action, yes. Instead of seeing it as just another
burden, another task to add on, clinicians can
approach adapting their letter writing as a structured
project. A project aimed squarely at improving
patient care and communication effectiveness.
How might that look? Well, by setting specific
goals, maybe aiming for a certain readability
score in their letters, or committing to using
patient -friendly templates for a particular
clinic, and then actively seeking feedback, they
can demonstrate professional growth, meet appraisal
requirements, and directly benefit their patients
all at the same time. It beds this crucial communication
skill firmly within the core clinical work, doesn't
it? Rather than leaving it as some sort of separate
admin task. Right. It shifts the perspective
from simply, oh, I have to write this letter
to something more like, I'm using this letter
as a tool to partner with my patient and make
sure they are truly informed and involved. That's
a powerful shift in perspective. Well, this deep
dive has really opened up the perhaps surprisingly
complex world of clinical letters for me and
hopefully for you, our listener too. We started
with that really powerful image, didn't we, of
a patient finally understanding their health
through reading a letter. And we've traced the
journey right from the core ethical imperative
in documents like Good Medical Practice through
the specific guidance from major bodies on what
needs to be in these letters, the essential content,
and critically, that need for plain understandable
language may be supported by tools like the Flesh
Score. Yes, the how -to. Exactly. We've delved
into the vital need for for tailoring letters
to different patient groups, different clinical
specialties, exploring the really nuanced and
sensitive language required, especially in areas
like psychiatry, using those real world examples
of how you phrase difficult information respectfully.
Which is so important. Absolutely. We've heard
about the significant emotional impact these
letters can have, the importance of transparency
and accuracy for building trust, and the real
value of inviting feedback as a quality improvement
measure. Closing the - Yes. And we've squarely
faced the practical barriers clinicians encounter
time, awareness, resources, alongside the concrete
strategies offered in the guidance to help overcome
them. Things like using templates, improving
dictation skills, working as a team while always,
always remembering that fundamental - ethical
rule about never delivering bad news via letter.
A crucial takeaway. Definitely. You know, thinking
about everything we've discussed, the absolute
necessity of knowing your audience, using plain
language, structuring information clearly, understanding
the emotional weight your written words can carry,
it really makes you think how these principles
extend far beyond just the clinical letter, doesn't
it? It does, absolutely. How often do we write
emails or reports or briefing documents in our
own professional lives that are just packed with
jargon or acronyms? assuming our audience has
exactly the same background knowledge we do.
This deep dive into patient letters, it feels
like a really powerful reminder that clear, audience
-tailored communication is a skill that's vital
in, well, countless professional contexts. It's
universally applicable, I think. I agree. Now,
if you found this deep dive helpful and perhaps
thought provoking, please do consider rating
and sharing the show. It genuinely helps more
people discover these important discussions and
hopefully gain some valuable insights. Thank
you so much for guiding us through this complex
but absolutely essential area of health care
communication today. It's been fascinating. It's
been a real pleasure improving how we communicate
in writing with patients. It just has such a
tangible positive impact on their health journey.
It really matters. It certainly does. And thank
you, our listener, for joining us on the Deep
Dive.