I had mixed feelings about the Academy of Royal Medical Colleges saying that too often correspondence between doctors, which patients are copied in on, contains too much medical jargon rather than plain English.
They do have a point. However, they have also missed the main point that this is primarily correspondence BETWEEN doctors which patients happen to be copied in on, not a letter to the patient.
Consider:
Dear GP, thank you for referring this 64-year-old man with a six-week history of melaena associated with anorexia and dysphagia. On examination he appeared cachectic and endoscopic examination revealed a 2 cm ulcerative lesion in the distal oesophagus which was biopsied and sent for histology. I will review him with the results.
Or:
Dear GP, thank you for referring me this 64-year-old man who has noticed his poo has been black for the last six weeks. He complains of being off his food and difficulty in swallowing. When I examined him he appeared very thin and when I passed the long tube with a camera on it down his food pipe I noted a very sore looking area at the lower end. I cut a bit of this sore area off and have sent it off to the laboratory to be examined down a microscope. I will see him in another outpatient clinic and discuss the results.
The Academy advises that consultants write to patients in plain English only, cc’ing the GP, and that they would only ‘rarely’ need to send a separate letter to the GP. But most GPs receiving a copy of the latter would feel patronised – and so would a lot of better educated patients. We use medical terminology because we are taught this at medical school and it allows us to describe precisely what we mean. Many conditions or symptoms cannot easily or accurately be translated into lay speak.
The implication behind asking us to use plain language is that we are in some way being elitist and secretive, which is not the case. It is just that sometimes a medical term allows us to describe exactly what we mean.
For instance, in the letter above, cachectic implies wasted due to a malignancy and is not necessarily the same as just ‘very thin’. It is a subtle difference, but one which we all learned as medical students.
The only way to solve this dilemma is to write two letters every time, as above and the patient letter would have to be tailored to the patient’s intellectual ability to avoid confusing or patronising them. I assume GP letters to consultants would also need to be written the same way? Result: duplication of secretaries’ work and almost certainly a yet further delay in us receiving clinic letters and referrals being made.
So yes, nice idea in theory but until we live in an ideal world, where there are infinite numbers of medical secretaries, as the Romans would say: ‘Cogitare iterum.’
Dr David Turner is a GP in north west London
