In September 2018 the Academy of Medical Royal Colleges published guidance on writing outpatient clinic letters to patients, advising clinicians to write directly to the patient and copy the letter to their GP. The guidance points out that this is in keeping with the NHS Constitution and Good medical practice, which states in paragraph 32 that, 'You must give patients the information they want or need to know in a way they can understand'.
Good medical practice is the ethical guidance published by the GMC. The wording used by the GMC is similar to that used by the GDC in Standards for the Dental Team, which says, 'You should find out what your patients want to know as well as what you think they need to know,' and, 'You must check and document that patients have understood the information you have given.'
The guidance from the Academy states that there are three main purposes of the outpatient letter:
- Record relevant facts about the patient's health and wellbeing
- Present information in a way that improves understanding
- Communicate a management plan to the patient and GP.
The Academy explains that some of the advantages of writing directly to the patient include the fact that clinicians themselves find the letters easier to understand, and less time is spent interpreting the contents of the letters. And of course, patients find the letters more informative, supportive and useful as well.
These advantages apply as much to dentistry as they do to medicine. They might also apply to letters of referral as well as letters back to the referring clinician, and it's worth thinking about using a plain English style in all correspondence between colleagues. Letters of referral should still be addressed to the referring clinician but a copy could be sent to the patient.
The guidance from the Academy does say that it is OK to use some medical jargon but that plain English should be used wherever possible. It can be difficult to remember what is jargon and what isn't because we are using the words day in and day out.
Dental professionals all understand what composite, amalgam and glass ionomer cement are, but they are not words widely understood by patients. Jargon can be essential to use when providing an accurate description to a colleague of the treatment provided or the condition of a patient. When dealing with a patient, one way around this would be to provide a basic description of the jargon in the letter to them; for example, 'A tooth coloured filling material called composite was used.'
Some other tips from the Academy include:
- remove redundant words such as 'actually' and 'really'
- use shorter sentences
- stick to one topic per paragraph.
The Academy says that it is important to explain any acronyms because 'these are often incomprehensible to non-specialists as well as to patients'. Even writing the acronym out in full is unlikely to clarify things for a patient; 'temporomandibular disorder' is just as likely to confuse a patient as using the acronym TMD.
An ideal solution is to include a brief explanation of the condition. It is hard to beat the one provided by the NHS on their website: 'Temporomandibular disorder (TMD) is a condition affecting the movement of the jaw.'
It is fine to use the acronym if it needs to be referred to later on in the letter. It just needs an explanation the first time it is used.
Communication issues are a regular factor in complaints faced by DDU members. By making the effort to communicate clearly and concisely with patients in a way they understand, you can minimise the risk of a simple misunderstanding becoming something more serious - as well as giving patients a greater sense of involvement in their own care.
Deputy head of the DDU
Leo Briggs qualified from University College Hospital, London, in 1989. He has worked extensively in the community dental service including a brief period overseas. He has also worked in general dental practice.
Leo gained a masters degree in periodontology from the Eastman in 1995 and is on the GDC specialist register for periodontics. From 1995-2017 he provided specialist periodontal treatment in both the salaried dental services and private practice. He started working for the DDU in 2005. Between 2007 and 2009 he worked part time at the DDU and part time as a clinical tutor at the School for Professionals Complementary to Dentistry in Portsmouth. In 2009 Leo went full time with the DDU. In January 2016 he became deputy head of the DDU.
See more by Leo Briggs