The Times

Chris Smyth, Health Editor

Gerry Gajadharsingh writes:

 “The most amazing thing is why this is not happening already. For at least 20 years whenever I write to a GP or specialist about a patient I tend to always copy in the patient. The reason why the letter is addressed to the doctor is that they are usually the one that has referred them, this is an accepted courtesy. These days these letters go by email to both the doctor and patient. Occasionally if it is to an NHS doctor it still has to go by snail mail! Amazing in the 21stcentury.

 Helping patients to understand what is wrong with them and the rationale of any proposed treatment and their prognosis (what is the chance of them getting better and how long might it take) is usually very helpful to the patient. This can be set out in the letter in language that people can understand. However, you can see the problem with using prognosis, that one word is much shorter that the explanation, all clinicians understand it but I’m sure some patients may have to look it up!

 There are many words used in medicine, not only ones that patients don’t fully understand, but ones that cause anxiety. “Degenerative change” is one that comes to mind. It is often reported on radiology reports (X-Rays and Scan reports) it simply means “wear and tear change”. It is common in almost anyone over the age of 40 to see some “wear and change” on imaging. That phrase is more user friendly than degenerative change, where patients often imagine that their spine or joint is crumbling!

 Interestingly it is NOT often the cause of patient’s symptoms.

 For example, if somebody develops acute neck pain 2 weeks previously, has an X-ray of their neck and are told they have degenerative change, often suggesting that this is the cause of the problem. When, if we imaged their neck the month before we would see exactly the same changes. Whilst these changes can make the particular area more vulnerable to injury and pain, patients will often settle down with the right sort of treatment, despite the changes on imaging.

 A recent unintended consequence of GDPR is that some patients are now opting out of consenting having any reports that I prepare, sent to their referring clinician or GP! This is a conundrum that clinicians are only now becoming aware of.

 I believe and many clinicians I have talked to also believe, that is in the patients’ best interest that ALL clinicians that play a part in their care have open communication and copying in patients to that correspondence. I expect it will lead to more problems for the patient if their clinicians are not aware of what is happening to them. But GDPR, being the latest of the increasingly burdensome bureaucracy facing all professions, we have to respect patients’ wishes. Let’s hope that there are not too many problems.”

Hospital doctors have been told to write to patients in plain English rather than sending “incomprehensible” letters to their GP.

Five million letters a month summarising outpatient appointments, must now go direct to patients avoiding the use of Latin, acronyms or technical terms, the Academy of Medical Royal Colleges says.

The academy, which sets standards for Britain’s 250,000 doctors, said that proper communication was central to good medical care.

Doctors will have to explain illnesses to patients using language at the reading level of a sixth-former. Proponents argue that clearer English addressed to patients will help to end the “paternalistic” culture of medicine.

Letters from hospital specialists to GPs setting out the results of appointments and specifying follow-up care frequently use medical terms or abbreviations such as “bd” or “renal”. These terms must be replaced with everyday English such as “twice a day” and “kidney”, the guidance says.

Doctors should also use short sentences and avoid the passive voice. The academy said that the letters should be addressed to patients with GPs copied in to make it clear that patients were in control of their care.

Last night campaigners welcomed the change but questioned why the NHS still relied on paper letters in a digital age.

Hugh Rayner, the kidney specialist who drew up the guidance, said that in the case of some letters sent by his colleagues “you need a PhD to read it, it’s so unnecessary”. Unusually, he began writing directly to patients more than a decade ago. “The change may seem small, but it has a big effect,” he said. “Writing to patients rather than about them changes the relationship between doctor and patient. It involves them more in their care and leads to all sorts of benefits.”

He added: “We are not dumbing down, we are cutting through the jargon.” Some hospital departments have already adopted the change, but Dr Rayner said: “Doctors are not known for their rush to change things. It’s been a limited spread . . . medicine has become so super-technical and we love acronyms.”

He urges patients to press hospitals that do not write to them to start following the guidance, which he says can be adopted universally with no extra cost.

Dr Rayner said that there was so little guidance on writing to patients that it was not even specified that letters should be typed rather than handwritten, although he added: “Doctors’ handwriting has traditionally been so bad that that would be discouraged.”

Peter Rees, chairman of the academy’s patient committee, said that the change would help people to “take ownership of their care”. He added: “It helps patients remember what was discussed in the outpatient clinic and gives them confidence that the doctor sees them as a person rather than a case.”

Kamila Hawthorne, vice-chairwoman of the Royal College of GPs, which helped to draw up the guidance, said that she had “seen a number of patients who have asked me to ‘translate’ the letter they have received from the hospital”.

Change of tone
How a doctor might write to GP today: 
“Mr Bloggs had recently presented to the rapid access chest pain clinic with increasing shortness of breath on exertion and atypical chest pains. Following this he had an echo scan and MRI scan, which is suggestive of cardiac amyloidosis . . . the next step will be to take a biopsy to prove whether this is amyloid . . . I have explained to him there is no specific treatment.”

How the new letter might look: “Dear Mr Bloggs. You recently came to the rapid access chest pain clinic because of increasing breathlessness on exercise and chest pains. An echo scan and MRI scan suggested that you may have abnormal protein deposits in your heart muscle, a condition known as amyloidosis . . . the next step is to take a biopsy to look for amyloid protein. The treatment options may be limited.”