Background
Clinic letters are the primary method of communication between the hospital specialist and GP. Letters convey advice on management and are also an important part of the clinical record providing a summary of the consultation. Despite this, very little is known about the style of letters written by most hospital specialists (including dermatologists) and the preferences of GPs.
Some hospital specialists advocate the use of structured clinic letters, which include a list of diagnoses and problems with investigations, treatments and follow-up under subheadings. A growing body of evidence shows that GPs prefer to receive structured clinic letters from hospital specialists including paediatricians1–3 and orthopaedic surgeons.4
The aim of this study was to find out whether GPs prefer to receive structured or unstructured clinic letters from dermatologists.
Method
An electronic two-question questionnaire was sent to all general practice managers in Oxfordshire asking them to distribute it to GPs at their practice. One month was allowed for completion during which reminder emails were sent.
Respondents were shown two letters, one structured and the other unstructured (Fig 1), and asked which they would prefer to receive if the fictional dermatological patient described was registered at their practice. The letters had an equivalent word count (approximately 120 words) and differed only in the format and language used to describe the investigations, treatments and follow-up. We also asked how long a GP would typically spend reading a clinic letter offering a choice of five responses (Table 1).
Examples of structured and unstructured letters.
Response to the question ‘How long would you typically spend reading a clinic letter that had been sent to your surgery from secondary care services?’
Results
One hundred and fifty-seven GPs completed the survey including 123 partners, 26 salaried GPs and eight trainees (ST1 and above), amounting to one third of the approximately 450 GPs registered with the primary care trust at the time of the study. One hundred and forty-nine of the 157 GPs (96%) preferred the structured letter. One hundred and twenty-two GPs reported that they spend less than one minute reading a clinic letter (78%, Table Table 1).
Discussion
This survey demonstrates that GPs in Oxfordshire have a clear preference for structured dermatology clinic letters. This finding confirms the results of surveys in other specialties.1–4 This study also highlights how little time GPs typically spend reading letters.
The findings are limited by the sample size which represents only one third of the eligible population so response bias may have exaggerated the preference for the structured letter. We cannot validate the GPs' estimate of the time they spend reading clinic letters; however, the result is consistent with our experiences of general practice.
We did not examine the reasons why GPs prefer the structured letter but the limited time that a GP has to read a letter may explain the preference for this format. It is likely that headings and lists make a letter easier and quicker to read. With the current trend towards management of evermore complex diseases in the community, concise and clear communication between the physician and GP is vital. We propose that our dermatological patient would be representative of many of the patients managed by physicians across a range of specialties and the preferences of GPs in Oxfordshire would be representative of GPs across the NHS.
Trainees in our department are encouraged to use the structured format in clinic letters with subheadings for diagnosis, investigations, management and follow-up. Nevertheless, an internal audit demonstrated that only one half of the doctors in our department write structured letters. With such strong support for the structured clinic letter, dermatologists and other hospital specialists need to re-examine the format of their letters.
Footnotes
Letters not directly related to articles published in Clinical Medicine and presenting unpublished original data should be submitted for publication in this section. Clinical and scientific letters should not exceed 500 words and may include one table and up to five references
- Royal College of Physicians
