The widely reported Guidance from the Academy of Medical Royal Colleges appropriately called “please, write to me” states that doctors should be encouraged “to write most of their outpatient clinic letters directly to patients and send a copy of the letter to a patient’s General Practitioner”. This is being described by the Academy as “best practice”. The report goes on to outline why this is best practice saying that patients must be given information they want or need in a way that they can understand and it quotes the NHS constitution which states that the patients have the right to be given information about the test and treatment options available to them including the risks and benefits.
The emphasis is placed upon a patient centred communication style with the use of plain language encouraged and medical jargon stripped out. The patients’ comments are revealing “I can now understand the treatment I am having for my illness and I am happy to know that I making some progress along the way”; “I for one will have forgotten half of what you have told me by the time I get home”. The second quote is important, patients need a reminder, particularly where they have been told information in a stressful situation, and a clear letter addressed to them should help. The fact that letters provide continuity and give patients a ready way of keeping informed about their treatment, both for themselves, and, their family is emphasised as is the patient’s active involvement in their care so that they can alert their treating doctors to errors.
The report also encourages doctors to include test results together with confirmation that the doctor has seen them.
The report states that the outpatient letter should do three things:
- Record relevant factors about the patient’s health and wellbeing.
- Present information in a way that improves understanding.
- Communicate a management plan to the patient and the GP.
The report then goes on to advise on structure and content and reminds clinicians to use plain English and avoid excessive use of medical jargon or, where technical language is used, explain the meaning. The example that is given is “You have an irregular pulse. This is called atrial fibrillation”.
This guidance is to be welcomed. It places the patient at the centre of their treatment, encourages their involvement in treatment decisions, educates and informs them and gives them the opportunity to raise concerns. By addressing correspondence directly to patients you prevent the feeling of exclusion from the decision making and include the patient as an active participant.
The relevance of this in the context of medical negligence claims is that many of the claims that we see arise as a result of failure in communication. Where there is a lack of clarity there is always scope for error. Sometimes patients, when they review medical records with us, are aghast at some of the things that they see in the records because they had not understood (or sometimes had not been told at the time) what is revealed to them by our review.
This guidance marks a shift towards patient centred care which has got to be a good thing, is in the interests of patients who will feel empowered and better informed, but, more generally, encourages a relationship of partnership and trust between doctors and patients that, I predict, should mean that some basic errors will be eliminated which, in turn, means fewer claims which is, of course, to be applauded.
Let’s hope this move towards patient centred care continues to gather pace.