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Dr. Gita Modgil Dr. Anna Baverstock

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.

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Dr. Gita Modgil Dr. Anna Baverstock

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  1. Clinic Letter Training & Current PracticeA Regional Study in the light of Department of Health guidance Dr. Gita Modgil Dr. Anna Baverstock SpR Study Day Jan 2008

  2. 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

  3. Clinic Letters • Fundamental process of referral • Convey information from Dr to Dr • Valuable reference source • Evidence of informed consent process • Medico legal record

  4. 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

  5. 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

  6. Views of doctors? • Apprehension • Concerns • Confidentiality & consent • Child protection/fabricated illness • Life limiting conditions • Generate complaints/further work

  7. 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

  8. Professional bodies • General Medical Council • Good communication • Clinical Governance • NSF Part 1– Information & Consent • Copy letters to parents • MPS/MDU • Framework of competences

  9. 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?

  10. Our study • To determine current practice & training amongst Paediatric SpRs with regard to clinic letter writing • Structured questionnaire • All south-west core trainees

  11. 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 Education2001;35(12);1115

  12. Results - Feedback • 32% no feedback at all • 55% - consultants • Structure • 42% - secretaries • Structure & Style • 16% - parents • Content • Mostly informal • 86% found it helpful

  13. Results – Letter Style • 71% - free text & problem list • 52% - 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

  14. Results – DoH guidance • 58% SpRs aware of guidance • 30% not copying – why? • 17% had received trust information • Confusion around principles: • When not to copy letters? • Copying to young children? • Consent & confidentiality? • Third parties?

  15. 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%

  16. 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

  17. 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

  18. How can we improve? • Awareness & understanding of DoH guidance essential • Training in core years important • Formal feedback to trainees

  19. “ I wish people who have trouble communicating would just shut up.” Tom Lehrer

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