Teaching communication skills. Putting it on paper helps patient understanding.

Abstract

EDITOR,-I C McManus and colleagues rightly emphasise the importance of teaching communication skills, but they do not mention written communication. Sometimes at the end of a consultation the patient is so exhausted and confused that, however good the doctor's communication skills, he or she has difficulty in comprehending the opinion given and the advice proffered. In a randomised trial in the Milton Keynes department of psychiatry, in association with the applied psychology unit of Cranfield College of Aeronautics, colleagues and I found that this problem could be overcome by writing to the patient after an outpatient consultation and summarising both the patient's and the doctor's contributions to the consultation.Patients who received letters were significantly more pleased with the consultation than patients whose general practitioners received letters in the traditional way.2 Patients reported that the receipt of a letter increased their self esteem and made them feel valued by the service.' They pointed out that to be written to (rather than about) was to be treated as a sane and responsible person; this was especially important to those attending the psychiatric outpatient clinic, in many cases for the first time in their lives. The letters were read many times; they were frequently shown to other family members and so formed the basis of family discussion about the illness and its treatment. The referring general practitioner was sent a copy of the letter and so knew what the patient had been told by the psychiatrist. The patients were asked to bring the letters to follow up consultations and to request correction and clarification when necessary.Several patients spontaneously remarked, "Why can't all doctors do this?" In fact, letters and other forms of written summary have been found useful in other specialties2 4; why not general practice too?We found that the prospect of writing to the patient rather than to the general practitioner made our consultations more patient centred. They were harder work but more fun. Why not make some experience of writing to the patient a regular part of the medical student curriculum or general professional training?