Transcript Clinic Letter Training & Current Practice A Regional Study

Clinic Letter Training &
Current Practice
A Regional Study in the light of
Department of Health guidance
Dr. Gita Modgil
Dr. Anna Baverstock
SpR Study Day Jan 2008
Communication
“ There are four ways, and only
four ways, in which we have
contact with the world.
We are evaluated and classified
by these four contacts:
what we do, how we look, what we
say and how we say it.”
Dale Carnegie 1888 - 1955
Clinic Letters
• Fundamental process of referral
• Convey information from Dr to Dr
• Valuable reference source
• Evidence of informed consent process
• Medico legal record
Department of Health
• Improve communication
• Patient participation in care
• Good practice guidelines 2003
• Copies of clinic letter
• From April 2004
•
Department of Health, Policy & Guidance April 2003
Copying Letters to Patients: Good Practice Guidelines
What do families want?
• Department of Health pilot projects
• Parents & young people want copies
• Satisfaction improved
• Empowers patient/parent
Bartle DG, Diskin L & Finlay F. Copies of letters to the family.
Arch Dis Child 2004;89:1032-33
Clarkson JE, Merrick PL. Paediatricians’ reports to general practitioners:
should parents receive copies? J Paediatr Child Health 1993 Dec;29(6):451-4
Views of doctors?
• Apprehension
• Concerns
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Confidentiality & consent
Child protection/fabricated illness
Life limiting conditions
Generate complaints/further work
Doctor to doctor
• Views of GPs & consultants
– re content & standards
• Variation in desirable content & thoroughness
of communication
• Communication is complex
Campbell B, Vanslembroek K et al.
Views of doctors on clinical correspondence: questionnaire
Survey and audit of content of letters. BMJ 2004;328:1060-61
Professional bodies
• General Medical Council
– Good communication
– Clinical Governance
• NSF Part 1– Information & Consent
– Copy letters to parents
• MPS/MDU
• Framework of competences
Copying letters has arrived
• Expectation to copy letters
• Do we know what we are doing?
• Are we adequately trained?
• Do we know where to seek guidance?
Our study
• To determine current practice &
training amongst Paediatric SpRs with
regard to clinic letter writing
• Structured questionnaire
• All south-west core trainees
Results - Training
• 97% response rate
(31/32)
• 3% SpRs
- formal training
• 42% SpRs – informal training
• 16% had used SAIL assessment tool
• 90% would welcome training
•
Crossley JGM et al Sheffield Assessment Instrument for
Letters (SAIL) performance assessment using outpatient letters
Medical Education 2001;35(12);1115
Results - Feedback
• 32% no feedback at all
60
50
• 55% - consultants
40
– Structure
30
• 42% - secretaries
20
• 16% - parents
– Structure & Style
– Content
GPs
SpRs
Parents
Secretaries
0
Consultants
10
• Mostly informal
• 86% found it helpful
Results – Letter Style
• 71%
• 52%
- free text & problem list
- paragraph headings
• RCT of effects of structuring letters
• Previous filed clinic letter influential
Melville C, Hands S & Jones P. Randomised trial of the effects of structuring
clinic correspondence. Arch Dis Child 2002:86:374-5
Results – DoH guidance
• 58% SpRs aware of guidance
– 30% not copying – why?
• 17% had received trust information
• Confusion around principles:
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When not to copy letters?
Copying to young children?
Consent & confidentiality?
Third parties?
Results – Copying letters
• Only 52% currently copy letters
• 39% routinely ask parents
• 6% document consent to copy
• writing separate letters 26%
• using explanation paragraphs 13%
Results - Beliefs
• 90% SpRs believe copying letters will
– enhance communication,
– increase patient trust & concordance
• Only few believe it will lead to
– increased confusion & financial costs
– further workload to Drs & secretaries
Conclusions
• No formal training in written communication
– When not to send copies?
• Half SpRs currently copying letters
• 90% agree with benefits of copying
• Current training gap
How can we improve?
• Awareness & understanding of DoH
guidance essential
• Training in core years important
• Formal feedback to trainees
“ I wish people who have
trouble communicating
would just shut up.”
Tom Lehrer