Am I the only patient who has to ‘explain’ clinic letters to my GP?
Apparently not. Dr. Morgan, writing in the august BMJ (British Medical Journal) says A BMJ Opinion piece published in 2018 argued that clinic letters should be written “to” patients, not “about” them
Writing about working on the front line during the Covid-19 crises, he says “I think that the same should be true of our medical notes. When we put patients at the centre of all that we do—be it shared decision making or best interest decisions, or even simply holding their hand when families cannot do so—it seems odd that the perpetual record of that care should exclude them.
Whether he is writing about Covid-19 patients, or – as I do – writing for today’s cancer survivors, it seems very clear that these ‘clinic’ letters are written on the assumption that GP’s are the most important person in our treatment pathway, and they are in charge of our care, including changes.
Yet, as I have often found out, my doctors may not have time to read clinic letters. It’s no use assuming they will act on recommendations contained in a letter. I soon found out that if my copy of my clinic letter contains a suggestion – perhaps changing a drug dose, etc. – I can’t wait for the surgery to change my monthly dosset boxes. I MUST point this out when I request refils, otherwise it might not get done.
In reality GPs must have a mountain of clinic letters; so how many get filed in the correct folder, let alone are read? How often are we waiiting for a follow-up appointment to happen, then phone to find what’s going on – NOTHING!.
Instead, Morgan argues “we should perhaps flip the narrative—or, rather, return to what such communication should be all about. I went back and rewrote “(an) entry (in a) patient’s notes. “It now reads: “Hi Davide, today I spoke to your wife, and I could hear your young daughter babbling in the background. I explained that you were critically ill, and I was worried that you were so sick you might die.”
Morgan srgues that subtle changes in language can be powerful. “Although these changes may mean little in a biomedical or legal setting, I suspect that they could have an impact on numerous areas of medicine where we would least expect it. For example, patient diaries in some acute care settings may be helpful for patients and their families to read after their crisis is over. Such a diary is effectively a biography, where an autobiography is not possible—so, who better to address it to than the main protagonist without a voice?”
The biography above had a happy ending, or at least a new beginning. Morgan says “a few weeks later I was able to write “I spoke with your wife again today. I was so pleased to tell her that you were better, you were off the life support machine, and your daughter will soon have her daddy back.”
Fellow patients – take note. Many GPs don’t have enough time to act on clinic letters. It is up to us to ensure that whatever our consultant recommends in a letter is acted upon. Whether it is starting physiotherapy, change of drugs and/or dosage, a follow-up appointment, or whatever – it’s up to us to check this happens. Even more so post-Covid-19, when it is on the cards that the NHS is going to be overwhelmed. Just make sure YOUR appointment is on the cards, and not lost in an NHS ‘fog’.
Matt Morgan is an honorary senior research fellow at Cardiff University, consultant in intensive care medicine, research and development lead in critical care at University Hospital of Wales, and an editor of BMJ OnExamination.