This charming gentleman has had enough of GP letters

Time for hospital doctors to write direct to patients

If you have had a long-term illness which involves trips to hospital you will be used to what follows each visit - a letter to your GP bringing them up to date on the latest news about your condition, copied to you. They almost always use flowery expressions -”this charming gentleman” “this delightful lady”. - to describe you, the patient, and then descend into medical gobbledygook which most of us find hard to follow.

This week I took part in a webinar organised by the Royal College of Physicians with doctors impatient to change what they see as an outmoded way of communicating with patients. I was there to represent the patient’s voice and as someone who was diagnosed with ocular melanoma in late 2004 and with Parkinson’s in early 2019 I have folders full of the letters in question.

They have always struck me as an important but flawed way of communicating with patients. Important because a consultation with a hospital doctor can be a stressful affair and one often emerges struggling to remember what was said, flawed because they are written in a language which the GP speaks but which is alien to most of us.

I have looked up the letter written by a hospital registrar to my GP (or rather a doctor at my big London surgery I don’t think I have ever met) after my Parkinson’s diagnosis. At the top it says “Impression:Extrapyramidal features”, it refers to me as “this 60 year old right-handed gentleman who works for the BBC. as a reporter”, and the. word Parkinson’s does not crop up until the second page. I am far from convinced that the GP did more than skim it, and it did not add to my understanding of the challenges I was now facing.

But the doctors I joined on the webinar have a radical idea. They think these letters should be written to the patient and copied to the GP, not vice versa. Dr Hugh Rayner, a retired consultant nephrologist, has been pushing this idea for twenty years. He showed us a letter he received from a patient after he wrote directly to her. The woman said she was writing to thank him: “I'm referring to your letter to me….in which you write, ‘it was nice to meet you.’ I can tell you that just that simple line lifted my spirits, because you're addressing me as a person, not just a case study.”

He said that writing to patients after an appointment had proved transformative :”it changed the way I viewed the consultation. It made the emphasis shift from just diagnostics and treatment prescription to education and sharing a treatment plan and navigating patients through this.”

But two decades after this idea was first floated a majority of doctors are still addressing their letters to GPs rather than patients. Changing the culture in the NHS is a long, slow business as Dr Anne Kinderlerer, a consultant rheumatologist, showed us.

She had been at a very digitally savvy Trust which used voice recognition to capture what she said during a consultation which meant that preparing a letter which would mean something to the patient was a pretty swift and simple job.

But now she had moved to be a senior clinician at a hospital with much more primitive technology, which meant she had to dictate letters into a dictaphone for a medical secretary to type up, something which made her far less productive. Worse, she found that the hospital was stuck in the past.

“The first time I dictated a set of letters, I got a message from the secretary which said, ‘You appear to have dictated these letters to the patient. That's not what we do, and it doesn't work here. You need to dictate the letters to the GP.’”

There are great opportunities for AI here. I have written here before about companies like Tortus which can allow the doctor to come out from behind the computer screen by recording an appointment and then using generative AI to compose a letter, taking in data from the patient’s medical record. Mind you, the old saying ‘garbage in, garbage out’, still applies. If the AI is trained on old doctors’ letters, they will still generate lots of charming ladies and delightful men.

And Dr Kinderlerer points out that even if writing direct to patients becomes the norm, this kind of one-way interaction is beginning to look old-fashioned in a world where patients are used to communicating online with every other kind of organisation. She sees the NHS app becoming increasingly important for a more interactive doctor/patient relationship:

“It doesn't matter what patient portal your various hospitals use, you'll be able to access them all through your NHS app. Your blood results will tend to land in there automatically. And as we build systems, then patients will be able to ask clinicians for questions about those blood results and inquire about what they mean for their health.” That in turn will mean they may have to use AI chatbots to deal with simple. queries if they do not want to be overwhelmed with inquiries.

Still, doctors have got to get better at communicating. I’ve often thought that the most valuable thing a patient can have is their doctor’s email address. As a profession they are almost uniquely hostile to allowing their customers to communicate direct with them, though I am glad to say both my Parkinson’s consultant and the doctor overseeing my ocular melanoma are in my phone’s address. book.

Dr Hugh Rayner stressed how serious an issue this is, quoting a survey showing over half of the public had had a problem with poor communication in the NHS and 1 in 10 had seen their treatments affected by it. “If we don't sort this out,” he said,”I think the NHS is really going to be challenged.”