WEBVTT 00:00:00.000 --> 00:00:03.140 Okay, imagine this. You get a letter from your 00:00:03.140 --> 00:00:07.980 doctor and well, instead of this dense jargon 00:00:07.980 --> 00:00:10.220 filled thing that seems written for, I don't 00:00:10.220 --> 00:00:13.740 know, someone else entirely. You actually understand 00:00:13.740 --> 00:00:16.679 it. Everything. Your diagnosis, why they did 00:00:16.679 --> 00:00:19.379 certain tests, what the treatment really involves, 00:00:19.839 --> 00:00:22.559 and crucially, what happens next. Right. That 00:00:22.559 --> 00:00:24.640 moment of clarity. Exactly. That moment where 00:00:24.640 --> 00:00:27.579 you finally grasp your own health story. That's 00:00:27.579 --> 00:00:29.219 really what this deep dive is all about today. 00:00:29.359 --> 00:00:32.359 We've seen how powerful this can be. Patients... 00:00:32.399 --> 00:00:35.479 talking about finally understanding a diagnosis, 00:00:35.560 --> 00:00:37.920 maybe years after it was first mentioned, just 00:00:37.920 --> 00:00:39.820 by reading their notes. It's quite shocking when 00:00:39.820 --> 00:00:41.840 you hear that, isn't it? It really is. And yet 00:00:41.840 --> 00:00:44.100 we also know from research that, well, a lot 00:00:44.100 --> 00:00:46.240 of clinical letters just aren't that easy for 00:00:46.240 --> 00:00:48.500 patients to read. No, the evidence points that 00:00:48.500 --> 00:00:50.560 way. So that highlights a critical gap, doesn't 00:00:50.560 --> 00:00:52.560 it? A sort of fundamental challenge in how we 00:00:52.560 --> 00:00:55.119 communicate health care information today. So 00:00:55.119 --> 00:00:57.679 today we are taking a deep dive right into that 00:00:57.679 --> 00:01:00.979 gap. We're unpacking the whole world of clinical 00:01:00.979 --> 00:01:03.780 correspondence, focusing specifically on the 00:01:03.780 --> 00:01:06.319 guidance, the movement towards writing letters 00:01:06.319 --> 00:01:08.319 to patients, or at least making sure the letters 00:01:08.319 --> 00:01:10.780 patients get are clear and understandable for 00:01:10.780 --> 00:01:13.280 them. We've gathered quite a stack of sources 00:01:13.280 --> 00:01:15.959 for this, you know, important guidance from key 00:01:15.959 --> 00:01:18.900 players like NHS England, the Academy of Medical 00:01:18.900 --> 00:01:21.400 Royal Colleges, and specific groups like the 00:01:21.400 --> 00:01:23.640 Royal College of Psychiatrists, the Radiologists 00:01:23.640 --> 00:01:26.060 too. Yes, quite comprehensive guidance is emerging. 00:01:26.299 --> 00:01:28.670 And, crucially, we'll be looking at insights 00:01:28.670 --> 00:01:31.409 from a service evaluation study gives us a real 00:01:31.409 --> 00:01:34.530 snapshot of current practice and, importantly, 00:01:34.969 --> 00:01:37.269 the barriers clinicians actually face in making 00:01:37.269 --> 00:01:39.409 this shift happen. But you're very real barriers. 00:01:39.769 --> 00:01:42.489 Definitely. So our mission is to distill what 00:01:42.489 --> 00:01:45.170 these sources say is needed, why it matters so 00:01:45.170 --> 00:01:47.650 much, and, well, how it might actually be achieved 00:01:47.650 --> 00:01:49.730 in practice. OK. And to guide us through all 00:01:49.730 --> 00:01:51.549 this material, help us make sense of it, we have 00:01:51.549 --> 00:01:53.989 an expert with us who can synthesize all this 00:01:53.989 --> 00:01:55.870 guidance and really shed light on the practical 00:01:55.870 --> 00:01:58.640 side. Welcome. Thank you. It's a really vital 00:01:58.640 --> 00:02:00.739 area, this, so I'm very pleased to be discussing 00:02:00.739 --> 00:02:03.180 it. It really feels like sort of a pivotal moment 00:02:03.180 --> 00:02:05.219 in health care communication, doesn't it? I think 00:02:05.219 --> 00:02:07.920 it does, yes. So let's dive straight in. The 00:02:07.920 --> 00:02:10.039 sources, they make it pretty clear. This isn't 00:02:10.039 --> 00:02:12.580 just a suggestion anymore or a nice to have. 00:02:12.860 --> 00:02:14.960 There's a real powerful drive towards making 00:02:14.960 --> 00:02:17.060 sure patients get these letters and can actually 00:02:17.060 --> 00:02:20.860 understand them. What's the... The fundamental 00:02:20.860 --> 00:02:23.379 principle behind this shift, where is this imperative 00:02:23.379 --> 00:02:25.819 coming from? Well, fundamentally, it's rooted 00:02:25.819 --> 00:02:28.139 right in the ethical and professional duties 00:02:28.139 --> 00:02:31.300 that clinicians have. If you look at, say, the 00:02:31.300 --> 00:02:33.199 General Medical Council's good medical practice, 00:02:33.800 --> 00:02:37.639 the core principle is stated very clearly. Clinicians... 00:02:37.449 --> 00:02:40.189 must give patients the information they want 00:02:40.189 --> 00:02:42.330 or need to know in a way they can understand. 00:02:42.650 --> 00:02:44.629 Right. That seems pretty unambiguous. It is. 00:02:44.750 --> 00:02:47.590 And it's not exactly a new idea, but how we put 00:02:47.590 --> 00:02:50.169 it into practice is definitely evolving, giving 00:02:50.169 --> 00:02:52.870 patients a clear, understandable copy of their 00:02:52.870 --> 00:02:55.590 clinic letter that's a direct, tangible way to 00:02:55.590 --> 00:02:58.030 meet that obligation. OK. It moves things beyond 00:02:58.030 --> 00:03:00.550 just, you know, telling the patient something 00:03:00.550 --> 00:03:02.689 during what might be quite a rush of consultation. 00:03:02.949 --> 00:03:05.819 Which often happens. Indeed. It provides a written 00:03:05.819 --> 00:03:08.120 record they can actually go back to, digest in 00:03:08.120 --> 00:03:10.400 their own time. So it's really about transparency, 00:03:10.719 --> 00:03:13.099 then, and making sure information isn't just 00:03:13.099 --> 00:03:15.860 lost once you walk out the door. Precisely. And 00:03:15.860 --> 00:03:18.500 it's all part of this much broader move towards 00:03:18.500 --> 00:03:21.879 genuinely patient -centered care. Historically, 00:03:21.900 --> 00:03:24.039 as you mentioned right at the start, these letters 00:03:24.039 --> 00:03:26.680 were mainly, well, doctor -to -doctor communication, 00:03:26.759 --> 00:03:28.879 weren't they? Yeah, like a handover note. Exactly, 00:03:29.000 --> 00:03:31.500 a handover, a record for the file. But the whole 00:03:31.500 --> 00:03:34.379 landscape has shifted. Patients now, quite rightly, 00:03:34.960 --> 00:03:36.759 expect to be partners in their own health care. 00:03:37.039 --> 00:03:38.819 And this is reflected in the guidance coming 00:03:38.819 --> 00:03:41.580 from bodies like the Academy of Medical Royal 00:03:41.580 --> 00:03:44.159 Colleges. Their Please Write to Me campaign was 00:03:44.159 --> 00:03:46.639 really significant. Ah, yes, I remember that. 00:03:46.939 --> 00:03:48.620 And the Professional Records Standards Body, 00:03:49.360 --> 00:03:52.500 the PRSB, they also set standards for the structure 00:03:52.500 --> 00:03:55.580 and content of electronic health records, including 00:03:55.580 --> 00:03:58.319 these letters, specifically with patient access 00:03:58.319 --> 00:04:01.870 in mind. Even nice guidance often talks about 00:04:01.870 --> 00:04:04.330 clear communication and shared decision -making. 00:04:04.569 --> 00:04:07.169 Which needs accessible information. Exactly. 00:04:07.289 --> 00:04:09.909 You can't have shared decisions without shared 00:04:09.909 --> 00:04:12.990 understanding. So these bodies, they aren't just 00:04:12.990 --> 00:04:14.889 recommending this anymore. They're setting clear 00:04:14.889 --> 00:04:18.389 expectations. Standards that say providing understandable 00:04:18.389 --> 00:04:21.470 letters directly to patients is becoming the 00:04:21.470 --> 00:04:24.009 norm, you know, not the exception. So the expectation 00:04:24.009 --> 00:04:26.889 has changed. It has. It's shifting the primary 00:04:26.889 --> 00:04:28.709 purpose of the letter. It's still for professional 00:04:28.709 --> 00:04:31.170 communication, still for the record, but now 00:04:31.170 --> 00:04:33.930 it has this added crucial purpose of patient 00:04:33.930 --> 00:04:36.370 empowerment. That framing, shifting from a doctor 00:04:36.370 --> 00:04:38.829 to doctor record to a patient empowerment tool, 00:04:39.029 --> 00:04:40.889 that's really powerful, isn't it? I think so, 00:04:40.990 --> 00:04:43.209 yes. And the sources really hammer home why this 00:04:43.209 --> 00:04:45.889 matters by highlighting the actual benefits patients 00:04:45.889 --> 00:04:47.970 see. What do they tell us of the sort of concrete 00:04:47.970 --> 00:04:50.509 advantages? Well, the benefits that are detailed 00:04:50.509 --> 00:04:52.689 are quite significant, and they cover several 00:04:52.689 --> 00:04:55.699 areas. The most obvious one is just better patient 00:04:55.699 --> 00:04:58.240 understanding. Understanding their diagnosis, 00:04:58.819 --> 00:05:01.720 the overall care plan, the reasons behind treatment 00:05:01.720 --> 00:05:04.379 decisions. Makes sense. Think about a consultationship. 00:05:05.379 --> 00:05:08.220 It can be quite overwhelming, can't it? Patients 00:05:08.220 --> 00:05:10.079 might only take in a fraction of what's said, 00:05:10.360 --> 00:05:13.000 especially if it's complex medical stuff. A clear 00:05:13.000 --> 00:05:14.819 letter gives them a permanent record they can 00:05:14.819 --> 00:05:17.579 read, reread, maybe share with family. At their 00:05:17.579 --> 00:05:19.519 own pace. Exactly, at their own pace. And they 00:05:19.519 --> 00:05:22.120 can clarify things. This increased understanding, 00:05:22.120 --> 00:05:24.779 it fosters a sense of involvement, of control 00:05:24.779 --> 00:05:27.360 over their own health, which is absolutely fundamental 00:05:27.360 --> 00:05:30.660 to a patient -centered approach. Right. But it 00:05:30.660 --> 00:05:33.060 goes deeper than just understanding. The sources 00:05:33.060 --> 00:05:36.060 give some really quite stark examples that underline 00:05:36.060 --> 00:05:38.699 the consequences when this communication doesn't 00:05:38.699 --> 00:05:42.259 happen well. Oh, like what? Well, cases where 00:05:42.259 --> 00:05:44.600 patients discovered really significant diagnoses, 00:05:44.639 --> 00:05:46.540 things like post -traumatic stress disorder, 00:05:46.720 --> 00:05:49.959 PTSD, or emotionally unstable personality disorder. 00:05:50.439 --> 00:05:52.879 EUPD, years after these, were initially made 00:05:52.879 --> 00:05:56.120 by specialists. Years later, how did they find 00:05:56.120 --> 00:05:59.100 out? They only found out by accessing their old 00:05:59.100 --> 00:06:01.319 clinical records. You know, going through them 00:06:01.319 --> 00:06:03.660 painstakingly records that were never clearly 00:06:03.660 --> 00:06:05.639 communicated or explained to them at the time. 00:06:05.860 --> 00:06:09.540 Wow, years later. Well, that's staggering. What 00:06:09.540 --> 00:06:11.639 kind of impact does finding out like that have? 00:06:11.779 --> 00:06:15.129 Oh, the impact is profound. It means years. potentially 00:06:15.129 --> 00:06:18.430 lost, years where the patient didn't understand 00:06:18.430 --> 00:06:20.769 their own condition, didn't have the chance to 00:06:20.769 --> 00:06:23.209 fully engage with treatment or seek the right 00:06:23.209 --> 00:06:25.389 support for that diagnosis. You can imagine. 00:06:25.610 --> 00:06:28.769 It can lead to delayed treatment, massive misunderstandings 00:06:28.769 --> 00:06:31.350 about their own experiences, and significantly, 00:06:31.470 --> 00:06:33.750 it just erodes trust in the whole health care 00:06:33.750 --> 00:06:36.589 system. Of course. If you discover a major diagnosis 00:06:36.589 --> 00:06:38.569 about yourself sort of hidden away in records 00:06:38.569 --> 00:06:40.589 you weren't meant to read or couldn't understand 00:06:40.589 --> 00:06:43.550 if you did, it just creates this huge barrier 00:06:43.550 --> 00:06:46.379 for the future. Yeah, it sends a terrible message. 00:06:46.800 --> 00:06:49.420 It sends a message that you weren't seen as a 00:06:49.420 --> 00:06:52.639 key partner in your own care. And the sources 00:06:52.639 --> 00:06:56.000 use these examples very explicitly to say. This 00:06:56.000 --> 00:06:59.899 is precisely why clear, patient -directed communication 00:06:59.899 --> 00:07:03.139 in letters isn't just good practice. It's essential 00:07:03.139 --> 00:07:05.439 for ethical care. It's essential for effective 00:07:05.439 --> 00:07:07.899 treatment. And it's essential for building trusting 00:07:07.899 --> 00:07:10.220 relationships with patients. So the stakes are 00:07:10.220 --> 00:07:13.060 incredibly high then. It's not just about administrative 00:07:13.060 --> 00:07:15.160 tidiness. It's right at the heart of patient 00:07:15.160 --> 00:07:18.000 outcomes and trust. Absolutely. OK, so let's 00:07:18.000 --> 00:07:20.779 shift gears a bit from the why to the how. If 00:07:20.779 --> 00:07:22.459 you're sitting down to write a letter with the 00:07:22.459 --> 00:07:25.220 patient really in mind, what are the core components 00:07:25.069 --> 00:07:27.490 that need to be in there, according to this guidance. 00:07:27.829 --> 00:07:30.529 Okay, well first, it's probably crucial to clarify 00:07:30.529 --> 00:07:32.569 something. Well, one common way of doing this 00:07:32.569 --> 00:07:35.110 is to send the patient a copy of the GP letter. 00:07:35.209 --> 00:07:38.170 Right, the Carver copy approach. Yes. The guidance 00:07:38.170 --> 00:07:40.490 really emphasizes that the letter must be written 00:07:40.490 --> 00:07:43.310 with the patient being a primary intended reader. 00:07:43.649 --> 00:07:46.250 This might mean tailoring the language, maybe 00:07:46.250 --> 00:07:48.129 even structuring it slightly differently than 00:07:48.129 --> 00:07:50.529 you would for purely doctor -to -doctor communication. 00:07:50.790 --> 00:07:53.610 So it's not just hitting copy? Ideally not, no. 00:07:53.790 --> 00:07:56.610 or at least writing the original, knowing the 00:07:56.610 --> 00:07:58.930 patient will read it. The letter serves multiple 00:07:58.930 --> 00:08:01.610 purposes, multiple readers, the team, the GP, 00:08:01.750 --> 00:08:05.529 the patient. But its effectiveness for the patient 00:08:05.529 --> 00:08:07.410 has to be paramount if they're receiving it. 00:08:07.449 --> 00:08:09.509 OK, got it. So what information is essential? 00:08:10.009 --> 00:08:12.410 Well, the guidance across the various sources 00:08:12.410 --> 00:08:14.389 is actually pretty consistent on the essential 00:08:14.389 --> 00:08:17.139 information. It starts with the basics, clear 00:08:17.139 --> 00:08:19.959 patient details, their GP practice details. Then 00:08:19.959 --> 00:08:22.439 it moves into the medical specifics, but presented 00:08:22.439 --> 00:08:25.339 clearly. So the diagnosis, or if it's not firm 00:08:25.339 --> 00:08:27.639 yet, the suspected diagnosis and how you're going 00:08:27.639 --> 00:08:30.199 to clarify it. Right. Crucially, known allergies 00:08:30.199 --> 00:08:33.399 must be stated very clearly. Any medication changes 00:08:33.399 --> 00:08:35.799 made during or after the appointment need to 00:08:35.799 --> 00:08:39.059 be detailed. Then there's a really critical section 00:08:39.059 --> 00:08:42.340 outlining Actions. Actions. Yes. Clear instructions 00:08:42.340 --> 00:08:44.980 or tasks for different people. So, actions for 00:08:44.980 --> 00:08:47.440 the GP, actions for maybe the hospital clinician, 00:08:47.720 --> 00:08:49.679 and really importantly, actions for the patient 00:08:49.679 --> 00:08:52.080 themselves. Ah, the actions for the patient bit. 00:08:52.299 --> 00:08:54.340 That seems absolutely vital for clarity, doesn't 00:08:54.340 --> 00:08:56.600 it? It really is. It helps the patient understand 00:08:56.600 --> 00:08:59.059 exactly what they need to do next. Is it picking 00:08:59.059 --> 00:09:01.679 up a prescription, scheduling a follow -up, making 00:09:01.679 --> 00:09:04.460 a lifestyle change, monitoring symptoms? It needs 00:09:04.460 --> 00:09:07.330 to be spelled out. Okay. Alongside those actions, 00:09:07.570 --> 00:09:10.029 the letter should have a concise summary of the 00:09:10.029 --> 00:09:12.809 appointment itself. Key examination findings, 00:09:13.250 --> 00:09:16.470 test results discussed. And finally, clear information 00:09:16.470 --> 00:09:19.850 on the next steps. What's the overall plan? When 00:09:19.850 --> 00:09:22.450 and how will follow -up happen? And who should 00:09:22.450 --> 00:09:24.950 they contact if they have questions or problems 00:09:24.950 --> 00:09:27.549 down the line? That sounds quite comprehensive. 00:09:27.789 --> 00:09:30.129 It is. And the PRSB, which we mentioned, has 00:09:30.129 --> 00:09:32.549 been really helpful in standardizing headings 00:09:32.549 --> 00:09:35.029 for these outpatient letters. Mandatory headings, 00:09:35.490 --> 00:09:37.330 recommended headings to help clinicians structure 00:09:37.330 --> 00:09:40.070 all this information logically. That makes it 00:09:40.070 --> 00:09:42.590 easier for everyone, including the patient, to 00:09:42.590 --> 00:09:44.870 find what they need quickly. Highlighting that 00:09:44.870 --> 00:09:47.250 action section, maybe in bold or near the top, 00:09:47.590 --> 00:09:49.730 is also specifically recommended in some guidance. 00:09:49.950 --> 00:09:52.330 So clear structure, all the necessary facts. 00:09:52.889 --> 00:09:54.769 But the real sticking point, and something the 00:09:54.769 --> 00:09:56.730 research you mentioned highlighted, is the language 00:09:56.730 --> 00:09:59.210 itself, isn't it? The jargon barrier. How did 00:09:59.210 --> 00:10:02.649 the sources tackle that? Yes. This is arguably 00:10:02.649 --> 00:10:05.590 the most significant point. And it's hammered 00:10:05.590 --> 00:10:08.230 home consistently across all the guidance documents. 00:10:08.889 --> 00:10:13.309 The mandate is completely unambiguous. Use plain 00:10:13.309 --> 00:10:16.700 English. Simple. well, simple to say, avoid medical 00:10:16.700 --> 00:10:18.820 jargon and abbreviations wherever you possibly 00:10:18.820 --> 00:10:21.759 can. Now, that's much harder to do consistently 00:10:21.759 --> 00:10:24.080 when you're immersed in medical terminology day 00:10:24.080 --> 00:10:26.759 in, day out. I can imagine. So the guidance stresses 00:10:26.759 --> 00:10:29.539 that if you absolutely must use a medical term 00:10:29.539 --> 00:10:31.860 or an acronym, maybe there's no simple alternative, 00:10:32.279 --> 00:10:34.399 or it's essential for clarity with other professionals 00:10:34.399 --> 00:10:36.820 reading the letter, then you must explain it 00:10:36.820 --> 00:10:40.139 immediately and clearly. In plain language, for 00:10:40.139 --> 00:10:42.240 the patient. Can you do an example? Sure. So 00:10:42.240 --> 00:10:44.460 instead of just writing, say, ECG showed AF, 00:10:44.940 --> 00:10:46.539 you write something more like the heart trace, 00:10:46.740 --> 00:10:49.100 which is called an ECG, and measures the electrical 00:10:49.100 --> 00:10:51.080 activity of your heart, showed that your heart 00:10:51.080 --> 00:10:54.399 rhythm was irregular. This is called atrial fibrillation, 00:10:54.639 --> 00:10:58.240 or AF, for short. Oh, OK. So you explain the 00:10:58.240 --> 00:11:01.100 test, the term, and the acronym. Exactly. You 00:11:01.100 --> 00:11:03.840 unpack it. The Royal College of Psychiatrists' 00:11:04.019 --> 00:11:06.389 guidance. is particularly good on this, actually, 00:11:06.450 --> 00:11:08.889 giving loads of examples of how to simplify quite 00:11:08.889 --> 00:11:12.529 complex psychiatric concepts. Another specific 00:11:12.529 --> 00:11:15.210 instruction mentioned is using the common English 00:11:15.210 --> 00:11:17.929 names for medicines, not the Latin ones, which 00:11:17.929 --> 00:11:20.450 can be, well, totally incomprehensible to patients. 00:11:20.649 --> 00:11:23.370 It's about constantly asking yourself that question. 00:11:23.850 --> 00:11:27.309 If I got this letter without my medical training, 00:11:27.710 --> 00:11:30.149 would I understand every single word, every phrase? 00:11:30.440 --> 00:11:32.419 That's a really good test to apply, isn't it? 00:11:32.440 --> 00:11:34.580 And I think the sources even mention specific 00:11:34.580 --> 00:11:36.860 tools that can help with this. They do, yes. 00:11:37.419 --> 00:11:39.419 The Academy of Medical Royal College's guidance 00:11:39.419 --> 00:11:41.480 and also that service evaluation study we talked 00:11:41.480 --> 00:11:44.120 about, they explicitly mention using readability 00:11:44.120 --> 00:11:46.559 tools. The Flesh Readability Score is the main 00:11:46.559 --> 00:11:48.740 one mentioned. Flesh Score? How does that work? 00:11:48.899 --> 00:11:51.000 It's basically a formula. It looks at average 00:11:51.000 --> 00:11:53.820 sentence length and the average number of syllables 00:11:53.820 --> 00:11:56.919 per word in a piece of text. It then calculates 00:11:56.919 --> 00:12:00.519 a score, usually out of 100. Higher scores mean 00:12:00.519 --> 00:12:03.679 easier readability. It often corresponds to a 00:12:03.679 --> 00:12:06.220 U .S. school grade level, so a score of, say, 00:12:06.340 --> 00:12:09.700 60, 70, is generally considered easily understandable 00:12:09.700 --> 00:12:13.100 by an average 13, 15 -year -old, which is often 00:12:13.100 --> 00:12:15.639 used as a benchmark for public information. Okay. 00:12:16.200 --> 00:12:18.559 And the study used this? Yes. The service evaluation 00:12:18.559 --> 00:12:21.159 actually applied this flesh score to a sample 00:12:21.159 --> 00:12:23.730 of real clinical letters. And they found that 00:12:23.730 --> 00:12:26.509 a high percentage scored quite poorly on readability. 00:12:26.730 --> 00:12:28.610 So there's actual objective data showing the 00:12:28.610 --> 00:12:31.490 problem exists in practice. What does a poor 00:12:31.490 --> 00:12:33.610 score like that actually mean for a patient reading 00:12:33.610 --> 00:12:35.940 the letter? What means exactly what those patient 00:12:35.940 --> 00:12:38.139 quotes we discussed earlier illustrate it means 00:12:38.139 --> 00:12:40.700 difficulty understanding Needing to look things 00:12:40.700 --> 00:12:43.220 up. Maybe misunderstanding crucial information 00:12:43.220 --> 00:12:45.440 about their condition or their treatment plan, 00:12:45.440 --> 00:12:48.779 right? It creates barriers Exactly a letter that 00:12:48.779 --> 00:12:51.759 scores poorly on the flesh test is highly likely 00:12:51.759 --> 00:12:54.620 to have too much jargon Sentences that are too 00:12:54.620 --> 00:12:57.100 long and convoluted and probably poor structure, 00:12:57.120 --> 00:13:01.309 too This directly undermines those goals of patient 00:13:01.309 --> 00:13:03.029 empowerment and shared understanding we talked 00:13:03.029 --> 00:13:05.470 about. Yeah. It really reinforces the need for 00:13:05.470 --> 00:13:08.029 clinicians to be incredibly mindful of their 00:13:08.029 --> 00:13:10.389 writing style and maybe even to use these tools 00:13:10.389 --> 00:13:12.690 sometimes as a check or perhaps for training 00:13:12.690 --> 00:13:15.429 and feedback. It makes that abstract goal of 00:13:15.429 --> 00:13:17.970 plain English much more concrete and measurable, 00:13:18.190 --> 00:13:20.649 doesn't it? It does. It moves it from just subjective 00:13:20.649 --> 00:13:23.570 feedback. This was hard to read to objective 00:13:23.570 --> 00:13:26.539 data. The score is 45 on flash. That's really 00:13:26.539 --> 00:13:28.379 interesting. Precisely. And it underscores that 00:13:28.379 --> 00:13:30.340 while the principles are clear, actually implementing 00:13:30.340 --> 00:13:32.320 them takes real effort and attention to detail. 00:13:32.580 --> 00:13:34.899 Absolutely. Now, health care isn't one size fits 00:13:34.899 --> 00:13:37.240 all, obviously, and patients are incredibly diverse. 00:13:37.779 --> 00:13:39.860 The sources also spend quite a bit of time talking 00:13:39.860 --> 00:13:42.320 about tailoring these letters for specific needs 00:13:42.320 --> 00:13:44.940 in different clinical areas. How does the guidance 00:13:44.940 --> 00:13:48.200 handle that complexity? Yes. This is where the 00:13:48.200 --> 00:13:50.419 picture gets more nuanced. It's particularly 00:13:50.419 --> 00:13:52.620 highlighted in the Royal College of Psychiatrists' 00:13:52.820 --> 00:13:55.950 guidance, actually. While those fundamental principles, 00:13:56.250 --> 00:13:59.110 clarity, plain language, essential content they 00:13:59.110 --> 00:14:01.909 apply across the board, the way you present the 00:14:01.909 --> 00:14:04.409 information and the specific details you might 00:14:04.409 --> 00:14:07.990 include or emphasize absolutely must be adapted. 00:14:08.029 --> 00:14:09.929 Tailored to the individual. To the individual 00:14:09.929 --> 00:14:12.610 patient, yes. Their condition, their age, their 00:14:12.610 --> 00:14:15.690 specific circumstances. A rigid, templated approach 00:14:15.690 --> 00:14:18.830 just won't work without that flexibility. You 00:14:18.830 --> 00:14:21.899 really need to think. Who is receiving this letter 00:14:21.899 --> 00:14:24.059 and what do they need from it? Okay, let's break 00:14:24.059 --> 00:14:26.159 down some of the specific examples given in the 00:14:26.159 --> 00:14:29.279 sources What about say older people? What are 00:14:29.279 --> 00:14:31.399 the considerations there for older people the 00:14:31.399 --> 00:14:33.639 guidance points to specific things like potential 00:14:33.639 --> 00:14:35.759 cognitive impairment or memory difficulties? 00:14:35.940 --> 00:14:39.259 sending a very complex letter or One containing 00:14:39.259 --> 00:14:41.080 a difficult diagnosis that perhaps the patient 00:14:41.080 --> 00:14:43.080 doesn't fully recall discussing in the clinic 00:14:43.080 --> 00:14:46.700 that could be quite distressing Exactly distressing 00:14:46.700 --> 00:14:49.559 or just confusing So the guidance recommends 00:14:49.559 --> 00:14:52.139 actually checking with the patient first. Do 00:14:52.139 --> 00:14:54.799 they want to receive a letter? Particularly if 00:14:54.799 --> 00:14:57.200 maybe previous letters haven't been well received 00:14:57.200 --> 00:15:00.580 or caused upset. Right. Ask first. Yes. And in 00:15:00.580 --> 00:15:02.799 some situations, and this needs really careful 00:15:02.799 --> 00:15:05.100 thought and discussion with the patient, making 00:15:05.100 --> 00:15:06.919 sure it's in their best interest and respects 00:15:06.919 --> 00:15:09.600 their wishes as much as possible, it might be 00:15:09.600 --> 00:15:11.659 more appropriate for the letter to go to a nominated 00:15:11.659 --> 00:15:14.500 carer or a family member. To ensure the information 00:15:14.500 --> 00:15:16.919 gets to someone who can support them. Precisely. 00:15:17.000 --> 00:15:19.299 to ensure crucial information is available to 00:15:19.299 --> 00:15:21.419 those supporting them. It's a delicate balance, 00:15:21.460 --> 00:15:23.940 isn't it? Sharing information effectively while 00:15:23.940 --> 00:15:26.159 respecting the patient's autonomy and avoiding 00:15:26.159 --> 00:15:28.519 causing unnecessary distress. It sounds like 00:15:28.519 --> 00:15:30.399 it. And what about for children and adolescents? 00:15:30.480 --> 00:15:32.080 That seems like a completely different challenge 00:15:32.080 --> 00:15:35.440 again. Oh, it absolutely is. The approach in 00:15:35.440 --> 00:15:37.399 Child and Adolescent Mental Health Services, 00:15:37.840 --> 00:15:41.139 CAMHS, which is detailed in the psychiatric guidance, 00:15:41.779 --> 00:15:44.720 needs to be incredibly flexible. It has to respond 00:15:44.720 --> 00:15:47.620 to the child's developmental stage, their capacity 00:15:47.620 --> 00:15:50.200 to understand. For younger children, obviously, 00:15:50.600 --> 00:15:53.039 a traditional detailed clinic letter addressed 00:15:53.039 --> 00:15:55.860 to them just isn't appropriate. No. So you might 00:15:55.860 --> 00:15:58.299 send a much simpler letter directly to the child, 00:15:58.360 --> 00:16:00.879 maybe using very simple language, large font, 00:16:01.299 --> 00:16:03.700 perhaps even pictures or symbols. Ah, interesting. 00:16:03.740 --> 00:16:06.399 Focusing on key positive messages or actions 00:16:06.399 --> 00:16:08.679 relevant to them, like remember to try that breathing 00:16:08.679 --> 00:16:10.940 exercise we talked about. And then at the same 00:16:10.940 --> 00:16:14.100 time, a more detailed letter With all the clinical 00:16:14.100 --> 00:16:16.620 information, we'd go to the parents or guardians. 00:16:16.960 --> 00:16:19.000 Okay, so two versions potentially. Potentially, 00:16:19.159 --> 00:16:22.200 yes. And as adolescents get older, as their capacity 00:16:22.200 --> 00:16:24.779 to understand and make decisions increases, the 00:16:24.779 --> 00:16:28.379 communication has to adapt again. For older competent 00:16:28.379 --> 00:16:30.700 teenagers, you might need to tailor the letter 00:16:30.700 --> 00:16:33.279 primarily to them. Maybe even send it only to 00:16:33.279 --> 00:16:35.519 them, depending on confidentiality considerations 00:16:35.519 --> 00:16:37.600 and their wishes. Much like you would for an 00:16:37.600 --> 00:16:39.659 adult. Right, respecting their growing autonomy. 00:16:40.159 --> 00:16:42.940 Exactly. The guidance also mentions using tools 00:16:42.940 --> 00:16:45.360 during the consultation for children. Things 00:16:45.360 --> 00:16:48.559 like crib sheets with pictures or symbols that 00:16:48.559 --> 00:16:51.440 explain key concepts or plans visually. They 00:16:51.440 --> 00:16:53.960 can then take that home, so it supplements the 00:16:53.960 --> 00:16:56.360 formal letter that goes to the GP and appropriate 00:16:56.360 --> 00:16:59.799 family members. So thinking beyond just the traditional 00:16:59.799 --> 00:17:02.740 letter format as well, perhaps using other tools? 00:17:03.279 --> 00:17:05.400 Exactly that. It's about using all the communication 00:17:05.400 --> 00:17:07.920 tools you have available and tailoring them to 00:17:07.920 --> 00:17:11.900 your audience. And in CMHS, that means recognizing 00:17:11.900 --> 00:17:14.539 you often have multiple audiences with very different 00:17:14.539 --> 00:17:16.660 needs. Makes sense. And the guidance touches 00:17:16.660 --> 00:17:19.279 on nuances in other areas, too. For instance, 00:17:19.380 --> 00:17:22.000 in eating disorder services, the letter content 00:17:22.000 --> 00:17:23.880 will likely need to include specific numbers 00:17:23.880 --> 00:17:26.519 that might be sensitive but are clinically vital. 00:17:27.039 --> 00:17:30.680 current weight, height, BMI, progress towards 00:17:30.680 --> 00:17:33.440 target weight, that sort of thing. Liaison psychiatry 00:17:33.440 --> 00:17:35.839 leaders often need to explicitly link mental 00:17:35.839 --> 00:17:38.400 health issues to physical health conditions that 00:17:38.400 --> 00:17:41.150 might be underlying or co -occurring. Forensic 00:17:41.150 --> 00:17:43.049 psychiatry leaders have to include summaries 00:17:43.049 --> 00:17:46.130 of relevant forensic history, details of legal 00:17:46.130 --> 00:17:48.809 status, like detention under the Mental Health 00:17:48.809 --> 00:17:52.509 Act, which needs very specific, careful phrasing. 00:17:52.750 --> 00:17:55.630 Right, very specific requirements there. Yes, 00:17:55.730 --> 00:17:57.930 and in oncology there are already established 00:17:57.930 --> 00:18:00.009 templates for things like treatment summaries. 00:18:00.309 --> 00:18:03.289 These need to detail complex chemo or radiotherapy 00:18:03.289 --> 00:18:06.750 plans, and really critically, provide crystal 00:18:06.750 --> 00:18:08.730 clear instructions on how to manage potential 00:18:08.730 --> 00:18:11.869 side effects. The complexity there and the potential 00:18:11.869 --> 00:18:14.490 seriousness of side effects just demands exceptional 00:18:14.490 --> 00:18:16.549 clarity and accessibility. That really highlights 00:18:16.549 --> 00:18:18.930 how specific the content needs can be in different 00:18:18.930 --> 00:18:21.849 specialties. Sticking with the psychiatric guidance 00:18:21.849 --> 00:18:24.109 for a moment, which seems particularly detailed 00:18:24.109 --> 00:18:26.769 on this, there's a strong focus on handling sensitive 00:18:26.769 --> 00:18:28.829 information and maybe potential disagreements 00:18:28.829 --> 00:18:30.890 very carefully in the letter. Could you give 00:18:30.890 --> 00:18:33.119 us a bit more insight into that aspect? Yes, 00:18:33.400 --> 00:18:36.980 this is a really crucial and quite subtle aspect 00:18:36.980 --> 00:18:39.140 of writing letters that patients will actually 00:18:39.140 --> 00:18:41.660 read, especially in psychiatry. The language 00:18:41.660 --> 00:18:44.000 used to describe someone's internal experiences, 00:18:44.240 --> 00:18:46.500 their behavior, it can be highly charged, can't 00:18:46.500 --> 00:18:48.599 it? Absolutely. The letter is a formal record. 00:18:48.779 --> 00:18:51.640 And if it uses language that feels judgmental 00:18:51.640 --> 00:18:55.039 or dismissive or just inaccurate from the patient's 00:18:55.039 --> 00:18:58.119 viewpoint, it can be incredibly damaging, damaging 00:18:58.119 --> 00:19:00.779 to trust, damaging to the therapeutic relationship. 00:19:01.119 --> 00:19:04.160 So how does the guidance suggest phrasing things? 00:19:04.400 --> 00:19:06.819 It gives specific practical examples. One key 00:19:06.819 --> 00:19:09.319 area is how you talk about a patient's perspective 00:19:09.319 --> 00:19:12.500 when it differs from the clinical view. The guidance 00:19:12.500 --> 00:19:15.259 strongly advises against using phrases like the 00:19:15.259 --> 00:19:17.680 patient having no insight into their condition. 00:19:17.819 --> 00:19:20.000 Why is that? because it sounds like a definitive, 00:19:20.359 --> 00:19:22.880 negative judgment on the patient. Instead, it 00:19:22.880 --> 00:19:24.839 suggests a more descriptive, more respectful 00:19:24.839 --> 00:19:26.859 approach that acknowledges both perspectives 00:19:26.859 --> 00:19:29.279 are present. The example given is excellent, 00:19:29.480 --> 00:19:33.380 I think. Instead of writing, patient has no insight 00:19:33.380 --> 00:19:35.279 into schizophrenia. You could write something 00:19:35.279 --> 00:19:38.220 like, I explained that my view is that these 00:19:38.220 --> 00:19:40.279 experiences are part of an illness called paranoid 00:19:40.279 --> 00:19:42.660 schizophrenia, and you disagree with this view. 00:19:43.279 --> 00:19:45.579 You do, however, agree that you are not currently 00:19:45.579 --> 00:19:47.839 feeling very well, and you are willing to follow 00:19:47.839 --> 00:19:50.619 the plan we discussed below. Ah, I see the difference. 00:19:50.839 --> 00:19:53.440 It acknowledges the clinician's view, states 00:19:53.440 --> 00:19:55.920 the patient's disagreement factually, but then 00:19:55.920 --> 00:19:59.519 finds calming ground on the plan. Exactly. It's 00:19:59.519 --> 00:20:01.559 objective reporting of a difference in perspective, 00:20:01.859 --> 00:20:04.039 rather than a loaded judgment about the patient's 00:20:04.039 --> 00:20:07.299 insight. It validates their stated position while 00:20:07.299 --> 00:20:09.220 still getting the clinical formulation across 00:20:09.220 --> 00:20:11.799 for other professionals. That's a really tangible 00:20:11.799 --> 00:20:14.079 difference in phrasing, isn't it? Much more respectful. 00:20:14.259 --> 00:20:16.059 It is. Another example they give is avoiding 00:20:16.059 --> 00:20:18.559 the word deny, particularly when reporting what 00:20:18.559 --> 00:20:20.839 a patient says about potentially stigmatizing 00:20:20.839 --> 00:20:23.920 behavior like maybe substance use. Why avoid 00:20:23.920 --> 00:20:26.990 deny? Because saying a patient denied taking 00:20:26.990 --> 00:20:30.289 drugs carries this subtle implication that you, 00:20:30.450 --> 00:20:32.970 the clinician, believe they're taking them and 00:20:32.970 --> 00:20:35.150 are being untruthful. Right. It sounds accusatory. 00:20:35.450 --> 00:20:38.289 It can do. So the guidance recommends replacing 00:20:38.289 --> 00:20:40.410 it with just objective reporting of what the 00:20:40.410 --> 00:20:43.210 patient said. So instead of patient denied taking 00:20:43.210 --> 00:20:46.480 illicit substances, you'd simply write, Patient 00:20:46.480 --> 00:20:49.099 reports not taking any illicit substances. It's 00:20:49.099 --> 00:20:52.039 a small change, but it removes that implied judgment. 00:20:52.119 --> 00:20:54.079 It does. It just reports the patient's statement. 00:20:54.420 --> 00:20:56.220 The example of Mrs. Pointer is another great 00:20:56.220 --> 00:20:58.799 illustration of this sensitive reporting. She's 00:20:58.799 --> 00:21:01.079 described as a patient with dementia who has 00:21:01.079 --> 00:21:03.440 fixed beliefs about her neighbors entering her 00:21:03.440 --> 00:21:06.480 house. Okay. The letter to her needed to communicate 00:21:06.480 --> 00:21:08.940 the clinical understanding of this, but without 00:21:08.940 --> 00:21:11.259 being confrontational or just dismissing her 00:21:11.259 --> 00:21:13.319 lived experience, which is very real to her. 00:21:13.500 --> 00:21:16.569 Very. The guidance suggests phrasing it carefully. 00:21:17.009 --> 00:21:19.690 The letter explicitly states the doctor's view 00:21:19.690 --> 00:21:23.329 that these experiences are likely related to 00:21:23.329 --> 00:21:25.930 your memory problems, and it uses the clinical 00:21:25.930 --> 00:21:29.849 terms delusions and hallucinations. But it immediately 00:21:29.849 --> 00:21:32.509 balances this by adding something like, you are 00:21:32.509 --> 00:21:33.950 clear that your neighbors are making the noises 00:21:33.950 --> 00:21:36.390 in your house, and you did not agree with my 00:21:36.390 --> 00:21:38.410 suggestion that these experiences might be linked 00:21:38.410 --> 00:21:41.210 to your memory problems. So again, presenting 00:21:41.210 --> 00:21:44.009 both sides. Precisely. presenting the clinical 00:21:44.009 --> 00:21:46.690 interpretation and the patient's strongly held 00:21:46.690 --> 00:21:49.410 differing perspective. It demonstrates respect 00:21:49.410 --> 00:21:51.589 while still maintaining the necessary clinical 00:21:51.589 --> 00:21:53.700 record. It sounds that the underlying principle 00:21:53.700 --> 00:21:56.500 is report the facts, report the differing perspectives 00:21:56.500 --> 00:21:59.279 neutrally, don't embed clinical judgment in a 00:21:59.279 --> 00:22:01.380 way that feels invalidating to the person reading 00:22:01.380 --> 00:22:03.480 it. That's a very good summary of it, yes. What 00:22:03.480 --> 00:22:05.740 about including something like the mental state 00:22:05.740 --> 00:22:08.859 examination, the MSE? That must feel quite clinical, 00:22:09.039 --> 00:22:11.299 maybe a bit odd for a patient to read about themselves. 00:22:11.859 --> 00:22:13.579 Yes, the mental state examination is, you know, 00:22:13.700 --> 00:22:16.019 a standard part of any psychiatric assessment. 00:22:16.079 --> 00:22:18.660 So it's a necessary component of the clinical 00:22:18.660 --> 00:22:21.250 letter for professional communication. But you're 00:22:21.250 --> 00:22:23.670 right, reading a description of your own appearance, 00:22:23.970 --> 00:22:26.369 your mood, your thoughts, your perceptions, all 00:22:26.369 --> 00:22:29.450 in clinical language, they can feel very strange 00:22:29.450 --> 00:22:31.950 indeed for a patient. I can imagine. How does 00:22:31.950 --> 00:22:35.470 the guidance suggest handling that? It acknowledges 00:22:35.470 --> 00:22:38.099 it directly. They suggest handling it by actually 00:22:38.099 --> 00:22:41.420 explaining what the MSE is for right there in 00:22:41.420 --> 00:22:43.660 the letter to the patient. Ah, explaining its 00:22:43.660 --> 00:22:47.160 purpose. Yes. The example phrasing suggests describing 00:22:47.160 --> 00:22:49.460 it as something like a brief description of how 00:22:49.460 --> 00:22:51.880 you seemed during the appointment in terms of 00:22:51.880 --> 00:22:53.559 your appearance and how you were thinking and 00:22:53.559 --> 00:22:56.599 feeling. And then crucially, they suggest adding 00:22:56.599 --> 00:22:59.900 context, like this might seem strange to read, 00:23:00.019 --> 00:23:02.680 but these snapshots are useful in keeping track 00:23:02.680 --> 00:23:05.279 of how you were doing over time. OK, so it frames 00:23:05.279 --> 00:23:08.920 it. It frames it. It preempts the patient's likely 00:23:08.920 --> 00:23:11.559 reaction. Why are they writing about how I looked? 00:23:13.099 --> 00:23:16.220 And frames that section not as some sort of clinical 00:23:16.220 --> 00:23:19.700 dissection of them, but as a useful tool. for 00:23:19.700 --> 00:23:21.900 tracking their progress, their journey. It makes 00:23:21.900 --> 00:23:24.579 it feel less alienating, hopefully. That makes 00:23:24.579 --> 00:23:27.240 sense. It's about providing context and purpose 00:23:27.240 --> 00:23:30.440 for potentially confusing clinical stuff. Exactly. 00:23:30.579 --> 00:23:32.640 It really highlights that every single part of 00:23:32.640 --> 00:23:34.759 the letter needs thinking about from the patient's 00:23:34.759 --> 00:23:37.000 viewpoint, doesn't it? It really does. We've 00:23:37.000 --> 00:23:38.660 touched on the patient perspective quite a few 00:23:38.660 --> 00:23:41.140 times, but let's dive a bit deeper into the actual 00:23:41.140 --> 00:23:43.519 experience of receiving and reading these letters 00:23:43.519 --> 00:23:46.079 as described in the sources. What did they find? 00:23:46.359 --> 00:23:48.569 Well, The patient quotes included in some of 00:23:48.569 --> 00:23:50.410 the source documents are incredibly insightful, 00:23:50.410 --> 00:23:53.049 I think, because they capture the real emotional 00:23:53.049 --> 00:23:55.069 weight these letters can carry. Right. It's not 00:23:55.069 --> 00:23:57.549 just about transferring information. It's about 00:23:57.549 --> 00:23:59.930 encountering this formal written description 00:23:59.930 --> 00:24:02.750 of yourself and your health challenges. Yeah. 00:24:02.849 --> 00:24:04.849 As one patient apparently said, reading their 00:24:04.849 --> 00:24:07.470 notes made me realize the reality of my mental 00:24:07.470 --> 00:24:10.670 health. So for some, it brings a difficult truth 00:24:10.670 --> 00:24:13.369 into much sharper focus. A moment of reckoning, 00:24:13.430 --> 00:24:16.900 perhaps? Perhaps. For others, the experience 00:24:16.900 --> 00:24:20.019 can be quite uncomfortable. One quote was, read 00:24:20.019 --> 00:24:23.420 the notes and cringe. Sometimes I didn't even 00:24:23.420 --> 00:24:26.660 recognize the person, would just rip it up. Wow. 00:24:27.000 --> 00:24:29.180 That really underscores that the language, the 00:24:29.180 --> 00:24:31.859 tone, the content, they aren't just academic 00:24:31.859 --> 00:24:35.059 points, are they? They have a real tangible emotional 00:24:35.059 --> 00:24:37.740 impact on the reader. A poorly written letter. 00:24:37.920 --> 00:24:40.240 even if it's factually correct from a clinical 00:24:40.240 --> 00:24:42.519 standpoint, could be quite distressing, maybe 00:24:42.519 --> 00:24:44.380 even triggering for some people. Definitely. 00:24:44.559 --> 00:24:47.119 But conversely, a clear, sensitive letter can 00:24:47.119 --> 00:24:50.099 provide immense relief and validation. It reinforces 00:24:50.099 --> 00:24:51.940 the information discussed in the consultation, 00:24:52.000 --> 00:24:54.640 which, as we said, can easily be partially forgotten 00:24:54.640 --> 00:24:56.779 or misunderstood in the moment. Gives you something 00:24:56.779 --> 00:24:59.619 concrete? Yes. It lets patients process information 00:24:59.619 --> 00:25:02.740 at their own speed, on their own terms. It helps 00:25:02.740 --> 00:25:04.680 move them from being just a passive recipient 00:25:04.680 --> 00:25:07.279 of care towards being a more active participant. 00:25:07.440 --> 00:25:10.400 And accuracy seems absolutely fundamental here. 00:25:10.500 --> 00:25:13.420 Not just clinical accuracy for the record, but 00:25:13.420 --> 00:25:15.819 factual accuracy from the patient's perspective 00:25:15.819 --> 00:25:18.880 as a way to build trust. Precisely. The guidance 00:25:18.880 --> 00:25:22.619 explicitly links giving patients access to their 00:25:22.619 --> 00:25:24.759 letters with the opportunity for them to check 00:25:24.759 --> 00:25:27.380 for factual accuracy. Now, this isn't really 00:25:27.380 --> 00:25:29.920 about debating clinical opinions necessarily. 00:25:30.119 --> 00:25:32.559 More about the facts. More about ensuring dates 00:25:32.559 --> 00:25:35.660 are right. Symptoms are described as the patient 00:25:35.660 --> 00:25:37.960 actually reported them. The plan reflects what 00:25:37.960 --> 00:25:41.180 was agreed in the room. One patient quote, highlights 00:25:41.180 --> 00:25:43.579 this perfectly describing how they and their 00:25:43.579 --> 00:25:46.819 husband read a letter and had. a matter of interpretation. 00:25:47.160 --> 00:25:49.680 Ah, interesting. It points to the fact that even 00:25:49.680 --> 00:25:52.019 with clear communication, different people can 00:25:52.019 --> 00:25:53.500 take different meanings from the same words, 00:25:53.539 --> 00:25:56.240 can't they? Especially if it's complex or describes 00:25:56.240 --> 00:25:59.000 subjective experiences. Very true. So giving 00:25:59.000 --> 00:26:01.319 patients the chance to say, actually, that wasn't 00:26:01.319 --> 00:26:03.640 quite what I meant or hang on, this data is wrong, 00:26:04.299 --> 00:26:06.519 that strengthens the relationship. It shows the 00:26:06.519 --> 00:26:09.180 clinician values, their perspective is committed 00:26:09.180 --> 00:26:11.359 to getting an accurate shared understanding. 00:26:11.700 --> 00:26:14.430 It shifts the dynamic, doesn't it? How so? Well, 00:26:14.569 --> 00:26:16.789 it shifts it from one where the clinician is 00:26:16.789 --> 00:26:19.069 the sole owner of the truth recorded in the letter 00:26:19.069 --> 00:26:21.509 to one where the patient is actually a partner 00:26:21.509 --> 00:26:23.990 in making sure the record reflects their experience 00:26:23.990 --> 00:26:26.970 accurately. A partner in accuracy. I like that. 00:26:27.269 --> 00:26:30.369 And how can clinicians actively encourage that 00:26:30.369 --> 00:26:32.910 feedback loop and maybe use it to improve? Well, 00:26:32.970 --> 00:26:35.470 the guidance recommends actively inviting feedback 00:26:35.470 --> 00:26:38.630 on the letters themselves, both from patients 00:26:38.630 --> 00:26:40.710 and also from other clinicians who receive them. 00:26:40.779 --> 00:26:43.960 like the GP. Okay. This is framed as a really 00:26:43.960 --> 00:26:46.579 crucial step for continuous quality improvement, 00:26:47.039 --> 00:26:49.779 improving communication skills. For a clinician, 00:26:50.119 --> 00:26:52.099 adapting their letter writing practice, maybe 00:26:52.099 --> 00:26:54.619 trying out new templates, really focusing on 00:26:54.619 --> 00:26:57.359 plain language that can be a powerful quality 00:26:57.359 --> 00:26:59.380 improvement project. Right, something tangible 00:26:59.380 --> 00:27:02.920 for appraisal. Exactly. seeking structured feedback 00:27:02.920 --> 00:27:05.099 from patients. You know, was this letter clear? 00:27:05.460 --> 00:27:06.900 Did it help you understand your condition and 00:27:06.900 --> 00:27:09.920 plan? What could we improve? And also from colleagues, 00:27:10.539 --> 00:27:13.500 was the relevant information easy to find? Was 00:27:13.500 --> 00:27:17.420 the terminology clear? It provides concrete data, 00:27:17.680 --> 00:27:19.740 data for reflection, for development. Makes sense. 00:27:19.960 --> 00:27:22.700 And the sources do mention that this whole process, 00:27:22.960 --> 00:27:25.579 reflecting on and improving communication, including 00:27:25.579 --> 00:27:28.819 letter writing, can and absolutely should be 00:27:28.819 --> 00:27:31.019 included in clinicians' professional appraisal 00:27:31.019 --> 00:27:34.119 portfolios. It links this vital skill directly 00:27:34.119 --> 00:27:37.339 to professional accountability and growth. So 00:27:37.339 --> 00:27:40.200 it's not just some abstract ideal floating out 00:27:40.200 --> 00:27:43.079 there. There are concrete mechanisms within professional 00:27:43.079 --> 00:27:45.559 development frameworks to actually encourage 00:27:45.559 --> 00:27:48.000 this. That's right. OK. We've talked a lot about 00:27:48.000 --> 00:27:50.660 the what and the why and how ideally this should 00:27:50.660 --> 00:27:53.180 all work. But that service evaluation study you 00:27:53.180 --> 00:27:55.579 mentioned also looked at the reality on the ground. 00:27:55.869 --> 00:27:58.450 you know, the barriers clinicians actually face 00:27:58.450 --> 00:28:01.309 in implementing this shift towards writing patient 00:28:01.309 --> 00:28:03.369 -friendly letters. What did that study find? 00:28:03.450 --> 00:28:05.930 What are the hurdles? Yes, that evaluation provided 00:28:05.930 --> 00:28:08.990 some really valuable practical insights. It surveyed 00:28:08.990 --> 00:28:10.930 clinicians to understand what was stopping them 00:28:10.930 --> 00:28:13.309 or making it difficult to consistently write 00:28:13.309 --> 00:28:15.349 letters with the patient as a primary audience 00:28:15.349 --> 00:28:17.890 or to tailor their existing letters appropriately. 00:28:18.170 --> 00:28:20.589 And what came back? Well, perhaps unsurprisingly, 00:28:20.769 --> 00:28:23.210 it showed that practice is still quite variable. 00:28:23.400 --> 00:28:26.099 Many of the letters they actually reviewed were 00:28:26.099 --> 00:28:29.220 still primarily written for the GP. And as we 00:28:29.220 --> 00:28:31.200 discussed earlier with the readability scores, 00:28:31.759 --> 00:28:33.440 they often weren't that easy for a layperson 00:28:33.440 --> 00:28:36.599 to understand. Okay. So what were the barriers 00:28:36.599 --> 00:28:39.259 clinicians mentioned? They were quite varied. 00:28:39.619 --> 00:28:41.940 Some clinicians indicated a perceived lack of 00:28:41.940 --> 00:28:44.240 need for change. You know, what we do now is 00:28:44.240 --> 00:28:47.640 fine. Or maybe just a lack of awareness that 00:28:47.640 --> 00:28:49.680 writing for the patient was actually the recommended 00:28:49.680 --> 00:28:52.390 standard now. Right. Lack of awareness. Resources 00:28:52.390 --> 00:28:54.529 were also mentioned things like access to specific 00:28:54.529 --> 00:28:56.869 software features, maybe templates or dedicated 00:28:56.869 --> 00:29:00.049 training time. But of a very significant barrier 00:29:00.049 --> 00:29:02.390 reported by a really high percentage of clinicians 00:29:02.390 --> 00:29:06.269 was simply time constraints. Ah, time, the perennial 00:29:06.269 --> 00:29:08.890 issue in health care. Always. The perception 00:29:08.890 --> 00:29:11.809 was... quite clearly that tailoring a letter 00:29:11.809 --> 00:29:14.369 specifically for a patient simplifying the language, 00:29:14.690 --> 00:29:16.730 maybe using a different template, would just 00:29:16.730 --> 00:29:18.769 take significantly longer than their established 00:29:18.769 --> 00:29:21.369 process, which is often dictating a standard 00:29:21.369 --> 00:29:24.450 letter aimed mainly at the GP. Right. Dictating 00:29:24.450 --> 00:29:27.730 the usual letter is quicker. So are there practical 00:29:27.730 --> 00:29:30.190 strategies suggested in the guidance or other 00:29:30.190 --> 00:29:33.650 sources to help clinicians overcome these, well, 00:29:33.990 --> 00:29:37.279 very real time and resource barriers? Yes, thankfully 00:29:37.279 --> 00:29:39.640 the guidance does offer some pragmatic solutions. 00:29:40.240 --> 00:29:42.920 One key strategy that comes up repeatedly is 00:29:42.920 --> 00:29:46.039 the use of available templates. Pre -made structures. 00:29:46.599 --> 00:29:49.000 Exactly. Bodies like the PRSB, the Royal College 00:29:49.000 --> 00:29:52.339 of Radiologists, McMillan Cancer Support. They've 00:29:52.339 --> 00:29:54.559 already developed templates for outpatient letters 00:29:54.559 --> 00:29:57.059 for treatment summaries that incorporate the 00:29:57.059 --> 00:29:59.700 recommended structure, the right headings, including 00:29:59.700 --> 00:30:02.440 things like actions for patient. Using these 00:30:02.440 --> 00:30:05.160 predefined templates can significantly cut down 00:30:05.160 --> 00:30:07.640 the time needed to structure the letter and helps 00:30:07.640 --> 00:30:10.180 ensure all the essential bits are included consistently. 00:30:10.319 --> 00:30:12.539 So don't reinvent the wheel every time. Precisely. 00:30:12.680 --> 00:30:14.440 Use the tools that are already designed with 00:30:14.440 --> 00:30:16.200 these principles built in. Makes sense. What 00:30:16.200 --> 00:30:18.680 else? For clinicians who dictate their letters, 00:30:19.400 --> 00:30:22.619 the RCR guidance specifically mentions improving 00:30:22.619 --> 00:30:25.819 dictation as a skill itself. This involves speaking 00:30:25.819 --> 00:30:28.279 clearly, structuring the dictation logically 00:30:28.279 --> 00:30:31.299 following the desired letter endings, and, crucially, 00:30:31.779 --> 00:30:33.980 working closely with administrative staff, with 00:30:33.980 --> 00:30:36.569 secretaries. How does that help? Well, working 00:30:36.569 --> 00:30:39.130 with them on using predefined styles or templates 00:30:39.130 --> 00:30:41.289 within the dictation system or the electronic 00:30:41.289 --> 00:30:44.390 health record software. Training for both clinicians 00:30:44.390 --> 00:30:48.170 and secretaries on efficient, patient -aware 00:30:48.170 --> 00:30:50.829 dictation and transcription that can streamline 00:30:50.829 --> 00:30:53.150 the whole process considerably. It makes it more 00:30:53.150 --> 00:30:55.210 of a team effort. They're leveraging administrative 00:30:55.210 --> 00:30:57.450 expertise to support the clinical goal. Okay, 00:30:57.549 --> 00:31:00.250 using the whole team. Yes. And there are also 00:31:00.250 --> 00:31:02.130 some crucial practical points about the medium 00:31:02.130 --> 00:31:04.450 of communication. The guidance is very clear. 00:31:04.619 --> 00:31:07.039 You must get consent for the patient before sending 00:31:07.039 --> 00:31:09.519 letters electronically. Obvious reasons, privacy, 00:31:10.019 --> 00:31:12.319 security. Absolutely critical. And perhaps most 00:31:12.319 --> 00:31:14.160 importantly, and this is reiterated very strongly 00:31:14.160 --> 00:31:16.700 across the sources, it's a fundamental ethical 00:31:16.700 --> 00:31:19.400 point. A letter should never be the first time 00:31:19.400 --> 00:31:21.539 a patient receives upsetting or difficult news. 00:31:21.920 --> 00:31:24.019 Never break bad news in a letter. Absolutely 00:31:24.019 --> 00:31:26.920 not. That includes diagnoses of serious illness, 00:31:27.660 --> 00:31:30.099 significant changes in prognosis, informing a 00:31:30.099 --> 00:31:32.940 patient about a major adverse event. That always 00:31:32.940 --> 00:31:36.000 requires a sensitive, direct conversation face 00:31:36.000 --> 00:31:38.519 -to -face ideally, or maybe a planned phone call. 00:31:39.319 --> 00:31:41.819 The letter's role is to summarize and reinforce 00:31:41.819 --> 00:31:43.759 information that's already been discussed verbally. 00:31:44.019 --> 00:31:45.700 Right, it supports the conversation. It supports 00:31:45.700 --> 00:31:47.880 the conversation. It must never replace the difficult 00:31:47.880 --> 00:31:50.960 parts of it. That's about managing patient expectations 00:31:50.960 --> 00:31:54.000 properly and avoiding causing significant distress 00:31:54.000 --> 00:31:56.339 through what can feel like very impersonal written 00:31:56.339 --> 00:31:59.420 communication. That ethical constraint is so, 00:31:59.420 --> 00:32:01.859 so important to remember, isn't it? And framing 00:32:01.859 --> 00:32:04.539 this whole shift as a quality improvement activity, 00:32:04.640 --> 00:32:06.220 as you mentioned earlier, that seems like quite 00:32:06.220 --> 00:32:09.079 a clever way to integrate it into a clinician's 00:32:09.079 --> 00:32:11.519 existing workflow and priorities, perhaps. I 00:32:11.519 --> 00:32:13.700 think it provides a really useful framework for 00:32:13.700 --> 00:32:16.519 action, yes. Instead of seeing it as just another 00:32:16.519 --> 00:32:19.819 burden, another task to add on, clinicians can 00:32:19.819 --> 00:32:22.359 approach adapting their letter writing as a structured 00:32:22.359 --> 00:32:25.730 project. A project aimed squarely at improving 00:32:25.730 --> 00:32:28.190 patient care and communication effectiveness. 00:32:28.450 --> 00:32:31.190 How might that look? Well, by setting specific 00:32:31.190 --> 00:32:33.829 goals, maybe aiming for a certain readability 00:32:33.829 --> 00:32:36.250 score in their letters, or committing to using 00:32:36.250 --> 00:32:38.049 patient -friendly templates for a particular 00:32:38.049 --> 00:32:41.069 clinic, and then actively seeking feedback, they 00:32:41.069 --> 00:32:43.710 can demonstrate professional growth, meet appraisal 00:32:43.710 --> 00:32:46.390 requirements, and directly benefit their patients 00:32:46.390 --> 00:32:50.170 all at the same time. It beds this crucial communication 00:32:50.170 --> 00:32:53.109 skill firmly within the core clinical work, doesn't 00:32:53.109 --> 00:32:55.490 it? Rather than leaving it as some sort of separate 00:32:55.490 --> 00:32:58.009 admin task. Right. It shifts the perspective 00:32:58.009 --> 00:32:59.990 from simply, oh, I have to write this letter 00:32:59.990 --> 00:33:02.289 to something more like, I'm using this letter 00:33:02.289 --> 00:33:04.490 as a tool to partner with my patient and make 00:33:04.490 --> 00:33:07.210 sure they are truly informed and involved. That's 00:33:07.210 --> 00:33:09.910 a powerful shift in perspective. Well, this deep 00:33:09.910 --> 00:33:12.210 dive has really opened up the perhaps surprisingly 00:33:12.210 --> 00:33:14.569 complex world of clinical letters for me and 00:33:14.569 --> 00:33:18.839 hopefully for you, our listener too. We started 00:33:18.839 --> 00:33:21.099 with that really powerful image, didn't we, of 00:33:21.099 --> 00:33:23.039 a patient finally understanding their health 00:33:23.039 --> 00:33:25.539 through reading a letter. And we've traced the 00:33:25.539 --> 00:33:28.680 journey right from the core ethical imperative 00:33:28.680 --> 00:33:31.799 in documents like Good Medical Practice through 00:33:31.799 --> 00:33:34.940 the specific guidance from major bodies on what 00:33:34.940 --> 00:33:36.940 needs to be in these letters, the essential content, 00:33:37.059 --> 00:33:40.119 and critically, that need for plain understandable 00:33:40.119 --> 00:33:43.119 language may be supported by tools like the Flesh 00:33:43.119 --> 00:33:46.319 Score. Yes, the how -to. Exactly. We've delved 00:33:46.319 --> 00:33:48.599 into the vital need for for tailoring letters 00:33:48.599 --> 00:33:50.880 to different patient groups, different clinical 00:33:50.880 --> 00:33:53.759 specialties, exploring the really nuanced and 00:33:53.759 --> 00:33:56.140 sensitive language required, especially in areas 00:33:56.140 --> 00:33:59.099 like psychiatry, using those real world examples 00:33:59.099 --> 00:34:01.539 of how you phrase difficult information respectfully. 00:34:01.660 --> 00:34:03.960 Which is so important. Absolutely. We've heard 00:34:03.960 --> 00:34:05.960 about the significant emotional impact these 00:34:05.960 --> 00:34:08.159 letters can have, the importance of transparency 00:34:08.159 --> 00:34:10.699 and accuracy for building trust, and the real 00:34:10.699 --> 00:34:13.280 value of inviting feedback as a quality improvement 00:34:13.280 --> 00:34:16.570 measure. Closing the - Yes. And we've squarely 00:34:16.570 --> 00:34:19.170 faced the practical barriers clinicians encounter 00:34:19.170 --> 00:34:23.150 time, awareness, resources, alongside the concrete 00:34:23.150 --> 00:34:25.309 strategies offered in the guidance to help overcome 00:34:25.309 --> 00:34:27.789 them. Things like using templates, improving 00:34:27.789 --> 00:34:31.349 dictation skills, working as a team while always, 00:34:31.429 --> 00:34:34.639 always remembering that fundamental - ethical 00:34:34.639 --> 00:34:37.619 rule about never delivering bad news via letter. 00:34:37.940 --> 00:34:40.260 A crucial takeaway. Definitely. You know, thinking 00:34:40.260 --> 00:34:42.900 about everything we've discussed, the absolute 00:34:42.900 --> 00:34:45.300 necessity of knowing your audience, using plain 00:34:45.300 --> 00:34:47.960 language, structuring information clearly, understanding 00:34:47.960 --> 00:34:50.139 the emotional weight your written words can carry, 00:34:50.260 --> 00:34:52.380 it really makes you think how these principles 00:34:52.380 --> 00:34:55.260 extend far beyond just the clinical letter, doesn't 00:34:55.260 --> 00:34:57.539 it? It does, absolutely. How often do we write 00:34:57.539 --> 00:34:59.860 emails or reports or briefing documents in our 00:34:59.860 --> 00:35:01.980 own professional lives that are just packed with 00:35:01.980 --> 00:35:04.619 jargon or acronyms? assuming our audience has 00:35:04.619 --> 00:35:06.619 exactly the same background knowledge we do. 00:35:07.460 --> 00:35:10.039 This deep dive into patient letters, it feels 00:35:10.039 --> 00:35:13.219 like a really powerful reminder that clear, audience 00:35:13.219 --> 00:35:15.980 -tailored communication is a skill that's vital 00:35:15.980 --> 00:35:19.239 in, well, countless professional contexts. It's 00:35:19.239 --> 00:35:21.650 universally applicable, I think. I agree. Now, 00:35:21.650 --> 00:35:24.309 if you found this deep dive helpful and perhaps 00:35:24.309 --> 00:35:27.010 thought provoking, please do consider rating 00:35:27.010 --> 00:35:29.710 and sharing the show. It genuinely helps more 00:35:29.710 --> 00:35:31.929 people discover these important discussions and 00:35:31.929 --> 00:35:34.610 hopefully gain some valuable insights. Thank 00:35:34.610 --> 00:35:37.389 you so much for guiding us through this complex 00:35:37.389 --> 00:35:40.329 but absolutely essential area of health care 00:35:40.329 --> 00:35:42.230 communication today. It's been fascinating. It's 00:35:42.230 --> 00:35:44.610 been a real pleasure improving how we communicate 00:35:44.610 --> 00:35:47.409 in writing with patients. It just has such a 00:35:47.409 --> 00:35:49.929 tangible positive impact on their health journey. 00:35:50.059 --> 00:35:52.659 It really matters. It certainly does. And thank 00:35:52.659 --> 00:35:54.539 you, our listener, for joining us on the Deep 00:35:54.539 --> 00:35:54.880 Dive.