Medical Clinic Referral Letters Do They Say What They Mean? Do They Mean What They Say?

Hodge, Joshua A.; Jacob, A; Ford, Mark; Munro, J.F.

doi:10.1177/003693309203700606

Cited by 8 publications

(7 citation statements)

References 2 publications

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“…11 Patients do not always seem to come to harm when the reason for referral is not correctly interpreted from the referral letter. 12 This may have been especially important to the setting of this study where patients are referred with the expectation of a diagnostic procedure being performed and all patients are seen regardless of the contents of the referral letter. The content of referral letters needs to be assessed from the perspective of the clinician engaged in a process-that is, organising a test.…”

Section: Discussionmentioning

confidence: 99%

Measuring the quality of referral letters about patients with upper gastrointestinal symptoms

Jiwa

Coleman²,

McKinley³

2005

Postgraduate Medical Journal

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Background General practitioners state the reason for referring patients in referral letters. The paucity of information in these letters has been the source of criticism from specialist colleagues. Objective To invite general practitioners to set standards for referral letters to gastroenterologists and to apply these standards to actual referral letters to one specialist gastroenterology unit. Methods A scoring schedule was designed based on the responses to a questionnaire survey of a large sample of all general practitioners in one locality. Altogether 350 consecutive letters to a district general hospital about patients referred for an upper gastrointestinal specialist opinion were subsequently scored using the schedule. Results 102 practitioners responded to the survey. Their responses imply that colleagues assess and record findings on 18 potential features of upper bowel disease. In practice most referral letters address fewer than six features of upper bowel disease. The mean number of positive features of upper gastrointestinal disease reported in each letter was one. Conclusions This study reported a failure to meet “peer defined” standards for the content of referral letters set by colleagues in one locality. Referral letters serve many purposes, however, encouraging full documentation of specific clinical findings may serve to increase the pre-referral assessments performed in practice.

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Section: Discussionmentioning

confidence: 99%

Measuring the quality of referral letters about patients with upper gastrointestinal symptoms

Jiwa

Coleman²,

McKinley³

2005

Postgraduate Medical Journal

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“…10 Communication standards in GUM between consultants and GPs remain a largely neglected area. Studies on communication between GUM clinics and GPs have in the past been restricted to problems related to HIV infected patients, 11 12 but the wider issue of communication for general STDs still remains unresolved.…”

Section: Introductionmentioning

confidence: 99%

Sexually transmitted diseases and communications with general practitioners

Winceslaus

Blount

Cryer

1999

Sexually Transmitted Infections

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Objectives: To devise a method of communicating with the general practitioners (GPs), overcoming the constraints imposed by patient confidentiality and the low levels of staYng in genitourinary medicine (GUM) clinics. To assess the GPs' responses to this method of communication. Setting: GUM clinics at two centres in Kent-Maidstone and Tunbridge Wells. Methods: Patients were recruited if they attended the clinic of their own accord without a letter of referral from their GPs; a definitive or provisional diagnosis was made and the patient was managed in the clinic; the patient's GP had received a conventional reply from the GUM clinic for other patients referred in the past. Separate GP letters were developed for male and female patients. These handwritten study letters were read by the patients who took the responsibility to deliver them to their GPs. This was followed by a questionnaire to the GPs. Results: 75 patients were eligible. Seven patients refused to participate. All questionnaires were returned by the GPs for the 68 participating patients (100%). Seven GPs failed to receive the study letter. For these unreferred patients, this was an improvement in communication level from 0% to 80%. 79% (95% confidence interval: 67%-87%) preferred the study letter, 97% (89%-99%) would like to receive a similar letter for future patients. All GPs thought that the study letter was at least as good as the standard letter, 52% (40%-64%) thought it was better. For 82% (70%-90%) it was the preferred format for future communication. Conclusion:The study has shown a way of establishing communication with GPs for patients who do not object to this. The results also suggest that in the study districts neither the GPs nor the majority of study patients had any objection to the sharing of information between the GUM clinics and GPs. (Sex Transm Inf 1999;75:45-48)

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“…Specialists’ letters have also been criticised for placing undue emphasis on reiterating a chronology of what the referring doctor already knows with regards to clinical history or recent management 6,10 . In contrast, anticipated effects of disease and/or its future treatment on quality of life and functional capacity are often not explicitly discussed, despite the influence they exert on patients’ likelihood of accepting and adhering to advice given, 18 and about which patients frequently seek second opinions from other doctors, particularly GPs 12,13 . Our results indicated that functional assessments were explicitly stated infrequently (<20% of cases), psychosocial factors were alluded to in only 40% of cases and specialists’ assessment of factors which may aid or inhibit patient adherence were mentioned rarely.…”

Section: Discussionmentioning

confidence: 81%

“…Studies of the quality of specialists’ letters to referring doctors note that many letters: (i) fail to adequately address the issues that prompted the referral, 12,13 (ii) inadequately enunciate reasoning underpinning the specialist's conclusions and recommendations, 12 (iii) contain too much technical information and not enough educational content, 13,14 (iv) omit follow‐up arrangements 13,16 and (v) are slow in being sent out 15 …”

Section: Discussionmentioning

confidence: 99%

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Audit of consultant physicians’ reply letters for referrals to clinics in a tertiary teaching hospital

Scott

Mitchell

Logan

2004

Internal Medicine Journal

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Opportunities exist for improving quality of consultant physicians' reply letters in terms of greater use of problem lists, contingency plans, prognostic statements and patient-centred assessments, as well as more frequent enunciation of consultants' reasoning behind requests for further tests and changes to current management. Use of structured letter templates may facilitate more consistent inclusion of key information to referring doctors.

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Medical Clinic Referral Letters Do They Say What They Mean? Do They Mean What They Say?

Cited by 8 publications

References 2 publications

Measuring the quality of referral letters about patients with upper gastrointestinal symptoms

Measuring the quality of referral letters about patients with upper gastrointestinal symptoms

Sexually transmitted diseases and communications with general practitioners

Audit of consultant physicians’ reply letters for referrals to clinics in a tertiary teaching hospital

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