Transcript ConsultLetterWriting07 - General Internal Medicine

CONSULTATION LETTER
WRITING AND DICTATION
AMBULATORY INTERNAL MEDICINE GROUP
PRACTICE CLINIC
Dr. Danny Panisko
Updated by Katina Tzanetos
Division of General Internal Medicine
University Health Network and University of Toronto
References:
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Writing effective consultation
letters: 12 tips for teachers
• Erin Keely et al. Medical Teacher,
Volume 24, No.6, pp. 585-589
CONSULTATION LETTER WRITING:
OBJECTIVES FOR THIS LECTURE
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Consider the role and characteristics of an
ideal consultation letter
Read and critique sample consultation
letters
Come to a consensus about the
characteristics of an ideal consultation
letter
CONSULTATION LETTER WRITING:
ROLE OF THE CONSULTATION
LETTER
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Potential readers:
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Referring physician
Consultant
Patient
Lawyers
Insurance companies
Need to think about all of these individuals
when dictating…but….
Focus should be on needs of referring
physician
ROLE OF THE CONSULTATION
LETTER: NEEDS OF REFERRING
PHYSICIAN
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Important tool for facilitating ongoing care
with Primary MD
Primary care MD often responsible for:
• Interpreting consultant’s opinion for patient
• Implementing diagnostic or therapeutic
suggestions
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Thus, letters should be received in timely
fashion and have specific
recommendations
ROLE OF THE CONSULTATION
LETTER: NEEDS OF REFERRING
PHYSICIAN
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Consultation letters may also be
used for Continuing Medical
Education by referring physician
Survey in 1995 looking at what
family mds wanted from letters
• Wanted guidance and education but
rarely received this
ROLE OF THE CONSULTATION
LETTER: NEEDS OF CONSULTANT
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Often only detailed record of
patient’s history, physical, and
follow-up plan
CONSULTATION LETTER WRITING:
Critique Sample Letters
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Consider discussing the following
characteristics of samples provided:
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Length
Content (new patients and f/u)
Format (hx, px…)
Use of Headings
Use of Typographical emphasis (bold or italic)
Use of Abbreviations
Report of Investigations
Recommendations
Physician Education
“Ideal” Letter
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From the discussion, determine
what your clinic’s letters will
look like
CONSULT LETTER WRITING:
For your information…from
the literature
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Most letters are read by family mds when
they arrive in mail and again on the day the
patient is being seen
Structured letters preferred over
unstructured letters
Editing experts recommend using 1-4
headings/page
Appearance of headings should stand out
Use point form for items such as
medications, pmhx, risk factors, and mgmt
plan
CONSULT LETTER WRITING:
For your information…from
the literature
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Three surveys showed that “essential
content” of a letter included:
• Study one (primary care and specialists referred
by a single oncologist):
• diagnosis, findings, test results, further tests,
treatment options and recommendations, benefits
and risks of treatment
• Study two (child psychiatry referrals):
• treatment and plan, specialist’s understanding of
problem, diagnosis, what parents were told and
date
• Study three (primary care physicians and
specialists):
• impression, plan, investigations to be done and by
whom, medication changes were among top 4
CONSULTATION LETTER WRITING:
Hints for successful dictation
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Always identify yourself, the patient, and the date of the
letter clearly
Leave your pager number in the dictation for the
secretary so she can contact you if she has any
questions
For the first few times, consider writing out in long hand
before dictating into the machine
Experiment with and become used to all of the
machine/system’s features
CONSULTATION LETTER WRITING:
Hints for successful dictation
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Speak slowly and enunciate clearly
Play back frequently to listen to yourself and make sure
you are understandable and complete
Always seek out the transcribed copies of your
dictations for your own feedback
Check how supervisors correct your dictations and
always ask for feedback from them
CONSULT LETTER WRITING:
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Apply your consensus on characteristics of
an ideal consultation letter to dictations for
the remainder of the year !
GOOD LUCK !