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Every day, I write (or, more correctly, dictate) numerous letters. I also read letters from other doctors and healthcare professionals. Despite this, I do not recall any formal teaching about how to write a letter, nor can I recall reading any publications on the subject. This perhaps explains why so many clinical letters are hopelessly inadequate—too short (mainly doctors), too long (mainly nurses), too impenetrable due to jargon, some even too offensive.1 My own letters are of course perfect (!). So, what is the secret?
Why write a letter at all?
Although letters documenting clinical interactions between a patient and their hospital doctor are commonplace in the UK National Health Service (NHS), this does not hold universally. There are many countries where letters are seldom written. Perhaps these countries have otherwise immaculate record keeping, but I cannot comprehend how they operate successfully without good communication. I write a letter following almost every clinical encounter—not only after outpatient consultations and discharge summaries (to the patient's general practitioner (GP) and copied to other involved health professionals) but also after inpatient consultations, and telephone discussions with patients, doctors and others. This is a lot of work (especially for my secretary), so why bother?
I believe the reasons for writing are twofold. First, to impart information to other professionals, most importantly the GP, but also other professionals involved in the patient's care, and often the patient too. Second, to provide me with an essential summary of what I thought at the time on the next occasion I see the patient. Without my letters, I am lost in the follow-up clinic, and spend valuable time going over old ground, rather than catching up with new information—this explains my frequent rage at lost medical records although the evolution of electronic storage has helped. Some suggest that clinical letters may also serve …
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