As most of you know, I’m a big fan of establishing good communication with the other practitioners (GPs, psychologists, osteopaths, specialists etc.) also caring for my patients and what began as occasional letters that I found exasperatingly difficult & time consuming to write has become second nature. That’s not to say every letter I write now hits the spot & evokes the desired response but I think I’ve got a pretty good run rate. So I put together some tips that I thought might help you either get started or get SMARRRTer at it!
- S – Service
- M – Medical language & conventions
- A – Accuracy
- R – Reasonable
- R – Rationale
- R – Respectful
- T – Time-conscious
- A summary of the most important medical aspects of the case is a great time saver for other health professionals & assists them in making better informed clinical decisions
- Summarise key points of reference
- e.g. Betty Smith (BMI 36kg/m2, Waist 92cm)
- e.g. Depression (diagnosed 2010, Zoloft 100mg/d)
- Pick out the salient features of the case
- What are the absolute must-knows in the case?
Medical language & conventions
- Only use medically accepted terms & diagnoses
- e.g. avoid naturopathic speak such as dysbiosis, adrenal fatigue etc.
- Quantify EVERYTHING relevant
- e.g. weight loss/gain (7kg in 3mo), DASS scores, stool Bristol type & frequency
- Include all units of measurement
- e.g. 4.6 mmol/L, 129/84 mmHg
- Summarise medical hx in table form for easy reference
- Clarify which details you have first-hand Vs second hand – be careful not to be part of Chinese whispers
- e.g. patient reports being diagnosed with lactose intolerance
- When including patients’ own words – use quotation marks
- e.g. patient reports feeling “dizzy & vague with brain fog most days”
- Clarify if some things have been self-prescribed – otherwise the assumption will be that you gave/recommended it to them
- Don’t use a scatter gun approach when suggesting investigations
- Try not to ask for subsidised testing that the GP is simply unable to do under subsidy
- e.g. Full thyroid function test can’t be subsidised without a prior diagnosis of thyroid disease or TSH outside of reference range…WEIRD BUT TRUE
- Present a brief, clear justification for any requests
- e.g. Iron studies (vegetarian diet)
- Include appropriate references when the justification is likely to be beyond expected knowledge
- e.g. as a deficiency of this vitamin has Vitamin D – both 25 (OH)D & 1,25(OH)2 D, been implicated in a large number of autoimmune conditions assessment of both forms is recommended (Smieth et al. Vitamin D in Autoimmunity. Am J Clin Nutr. 2013)
- Ask for their assistance/insight/review/guidance
- Don’t forget – you want & need it!
- Keep in mind also how the relationship your patient shares with this practitioner may be positively or negatively impacted by the respect & tone of your letter
- How far in advance should the GP receive your letter in order to give him/her adequate time to read & digest the content?
- e.g. too close to consult – GP might understandably feel ambushed/rushed/unprepared
- How much time does a GP or other professional have to spend with each patient?
- In summary the less words the better – look for ways to reduce your word count, cut to the chase and ideally get most letters down to 1 page