Dr Udvitha Nandasoma
Dr Udvitha Nandasoma highlights the importance of communicating with patients using language they will understand.
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 both 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'.
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 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 fine 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.
Medical professionals all understand everyday clinical terms such as sutures, renal and febrile, but many patients may not be familiar with them. 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, 'no axillary lymphadenopathy' might be worrying for a patient, whereas explaining that 'there were no enlarged lymph glands' might well be more reassuring.
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 sometimes not enough to clarify things; 'cardiac resynchronisation therapy defibrillator' is just as likely to confuse a patient as using the acronym CRT-D.
An ideal solution is to include a brief explanation of the condition when writing to a patient; the AoMRC's guidance uses the example of saying, 'You have an irregular pulse. This is called atrial fibrillation.'
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 MDU 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.
Dr Udvitha Nandasoma
BA MBBChir MRCP (UK) LLB(Hons)(Open) PhD MFFLM
Dr Udvitha Nandasoma joined the MDU as a medico-legal adviser in 2008 after completing specialist training in gastroenterology. His special interests at the MDU include advising on complaints. In addition to his work at the MDU, he also undertakes clinical practice in hepatology. He is the medical editor of the MDU Journal.
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