Dr Hugh C Rayner is a consultant nephrologist at Heart of England NHS Foundation Trust. Here, he talks about making the switch to writing directly to patients.

How would you feel if someone said you were pleasant? You might be flattered, or a little uneasy, or perhaps downright insulted that ‘pleasant’ is the best that could be said about you! If you have attended an outpatient clinic, there is a good chance that this is how you were described in a letter sent by the doctor to your GP.

You may have had a copy of that letter but, if not, you can ask your GP for access to your medical records online. When you read the letter, you may find it contains information you cannot understand or that worries you. You may even need to make an appointment with your GP to have the letter explained.

Improving how we communicate

Wouldn’t things be a lot easier and more helpful if the clinic doctor wrote the letter directly to you and copied this to your GP? Better still if the doctor wrote the letter in plain English and answered all your questions about your condition and its treatment. This is what most GP surgeries would prefer and is recommended by NICE, the NHS, medico-legal experts, and professional organisations.

However, only a minority of hospital doctors write their letters directly to patients. Many reasons are given why they don’t but, with some thought and a little imagination, they can almost always be overcome. And most doctors who make the change find that their patients are more satisfied and better equipped to cope with their condition as a result.

My experience

I started writing directly to patients in 2005, after my consultant colleague persuaded me that it was the right thing to do. At first I was nervous and sceptical, but I quickly came to realise that this was the most important change to my medical practice that I had made since becoming a consultant. I have since taken every opportunity to promote the practice and led a group of senior doctors from the Academy of Medical Royal Colleges to write a guidance document called Please, Write to Me.

The document featured on the BBC and I had the pleasure of contributing to an episode of Word of Mouth with Michael Rosen on Radio 4. The reaction from the public was amazing. I heard so many stories of how patients and their families had been confused and worried by letters they had received.

The problem

So why is it proving hard to get this practice taken up by doctors? Part of the problem lies with the apprenticeship model of medical education; traditional ways of working are passed down from seniors to juniors. Even if a doctor would like to do things differently, the department in which they work may resist the change.

A second factor is that doctors get little customer feedback; patients are generally very grateful for the care they receive and reluctant to make a fuss or rock the boat. So, there is no sense that things need to change or could be much better.

Making a difference

Doctors respond to two things, published evidence and peer pressure. Evidence that writing directly to patients is better is clear from many studies, which have been summarised in an article in the British Medical Journal. What is lacking is peer pressure from doctors and, more importantly, from patients.

This is where the Writing to Patients from Rheumatology project could make a big difference. The resources it produces will make it easier for a doctor to change their practice. But it is conversations that doctors have with their colleagues and patients that will make them want to change. Getting this right is crucial for the project to be a complete success.

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