Abstract

I greatly enjoyed David Thrush’s observations on taking a good history (Practical Neurology, 2002, 2, 113–116). There are two other outpatient practices that I believe are valuable. After initial introductions I read the referral letter out loud, so the patient then knows what I know about them and can fill in any gaps. This gives an immediate focus to taking the history and avoids the patient having to sit and watch me reading. Although some referral letters are still written in such a way that the writer had probably not intended the patient to know the contents, these are increasingly uncommon and may be made suitable by anticipatory and judicious paraphrasing. The second practice is that I dictate my letter in front of the patient and, as now recommended in the National Health Service Modernization Plan, send a copy to the patient. This has many advantages; firstly, it ensures