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It’s not as simple as writing in patet anglicus

Dr David Turner

Dr david turner duo 3x2

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

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Readers' comments (3)

  • I totally agree with what you say.
    I have been writing letters to patients and copyingbin GOs for a while now but I suspect that this leads to the GP paying even less attention to my letters that they did in the past ( I’m a psychiatrist so letters aren’t short). I tend to highlight sections that I really want the GP to read or attach a short email or note if sent.
    The upshot is that the work is increased. However, I know that writing to my patients has been very powerful for the patient and has allowed them to reflect a lot more on their difficulties than ever before. The letter is a therapeutic tool in itself. Pros and cons.

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  • Sending separate letters is not the only way to solve this dilemma.

    How about "He appeared very thin (cachectic)?"

    There could be a standard disclaimer at the start that words in brackets are technical words for the GP.

    I think the positives of writing the letters to patients probably outweigh the negatives.

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  • If doctors just decided to write in idiomatic English instead of the quasi erudite passive voice style, that delights in classically derived polysyllabic words over the short Anglo Saxon ones, it would go down well with both GP and patient.
    Thus,
    Dear Dr,
    The above patient is complaining of pruritic pigmented skin lesions, three in number, in the thoraco-lumbar region. When he was examined by myself, they were highly suggestive of a malignant diagnosis. I communicated this to the patient, and he elected to undergo excision surgery. He underwent the procedure, performed by myself, on April 1st. At 7 day review the scar appeared erythematous and pustular and a decision was taken by myself to commence the patient on antibiotic therapy etc
    Or....
    Dear Dr,
    Mr Smith has got three itchy brown spots on his back. They looked malignant to me. I advised him that he should have them removed, and he agreed. I removed them on April 1st. A week later the wound looked infected and I put him on antibiotics.
    I never actually got the first letter, it is a pastiche of some of the more annoying unidiomatic letters that we get. The only jargon term missing in the second version is 'thoraco-lumbar', which probably isn't necessary as the scar would show you were they had been, (or 'where they were situated' in the typical letter).
    I'm not against jargon, and 'a f' is a perfect example of how jargon speeds up communication between professionals. This turgid style isn't jargon, however, just bad writing. Simple letters are usually short, and easier to understand than the long polysyllabic ones.
    And why do doctors always talk about 'commencing' drugs?

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