Referral letters: are form letters better?

An essential mode of contact between general practitioners (GPs) and hospital staff is the referral letter. This must be clear and concise with sufficient information to aid the GP, the consultant and the patient. In order to ensure this, a proposal was made for the use of a structured or standardized referral letter: a form letter. This report shows that form letters were shorter than typed letters. Form letters were also proven to contain more information than nonform letters.     

Referral letters — the enclosure of the general practitioner's computerized record

The computerization of general practice records in group practices often makes it possible for a print-out of the record to be sent to hospital specialists on referral. I examined the assessments made by consultants of the value of this. While general practitioners and consultants do not agree on the content of the ideal referral letter, the addition of a computer print-out would aid about a third of consultants.     

Referral of suspected colorectal cancer: have guidelines made a difference?

In the United Kingdom, patients with colorectal symptoms referred on the fast-track pathway into secondary care are offered investigation of their symptoms within 2 weeks. Audits demonstrate that a minority of patients with colorectal cancer are referred under this arrangement. We assessed referral letters to hospitals in one district in the period before and after the introduction of the 2-week wait initiative. The guidelines appear to have made little difference to the proportion of cases selected for referral on the urgent pathway. However, cancers in the earliest stages present with fewer clinical features than advanced disease and a combination of signs and symptoms are more likely to arouse suspicion in the referring agent.     

Computer-generated tailored feedback letters for smoking cessation: theoretical and empirical variability of tailoring

Purpose

This study examines tailored feedback letters of a smoking cessation intervention that is conceptually based on the transtheoretical model, from a content-based perspective.

Methods

Data of 2 population-based intervention studies, both randomized controlled trials, with total N = 1044 were used. The procedure of the intervention, the tailoring principle for the feedback letters, and the content of the intervention materials are described in detail. Theoretical and empirical frequencies of unique feedback letters are presented.

Results

The intervention system was able to generate a total of 1040 unique letters with normative feedback only, and almost half a million unique letters with normative and ipsative feedback. Almost every single smoker in contemplation, preparation, action, and maintenance had an empirically unique combination of tailoring variables and received a unique letter. In contrast, many smokers in precontemplation shared a combination of tailoring variables and received identical letters.

Conclusion

The transtheoretical model provides an enormous theoretical and empirical variability of tailoring. However, tailoring for a major subgroup of smokers, i.e. those who do not intend to quit, needs improvement. Conceptual ideas for additional tailoring variables are discussed.     

Reverse Referral: From Pathology to Endocrinology

Establishing a diagnosis of multiple endocrine neoplasia type 1 (MEN1) especially in children, adolescents, and young adults can be challenging because of phenotypic heterogeneity even among family members. We report an adolescent girl diagnosed to have MEN1 following presentation with multiple collagenomas. Histological evaluation of her cutaneous lesions revealed >70 collagenomas. Hormonal evaluation included calcium, phosphate, and parathormone measurements. Exons 2–10 of the MEN1 gene and flanking intron–exon borders were sequenced and revealed a novel nonsense mutation, Y222X. Following the identification of the cutaneous lesions as collagenomas by the pathologist, the patient was referred for an endocrine evaluation which revealed asymptomatic primary hyperparathyroidism. The patient elected to have surgery at which time she was found to have parathyroid hyperplasia. This case emphasizes the usefulness of cutaneous findings for the diagnosis and management of MEN1.     

Copying general practitioner referral letters to patients: a study of patients' views.

Over the past decade there has been a significant shift towards greater involvement of patients in their health care and this has highlighted many areas relating to doctor-patient communication. One area of communication that has not been extensively researched is the referral letter between general practitioners (GPs) and their patients. This small study of patients' views suggests that patients value receiving a copy of their GP outpatient letter, appreciating greater understanding of, and involvement in, the referral process.     

Copying referral letters to patients: prepare for change

The National Health Service (NHS) Plan for England has directed that from April 2004 clinicians will offer patients the opportunity to receive copies of letters that are written about them. Patients like to have more information and patients who have received copies of letters have found them useful. It is hoped that copying letters will improve relationships between doctors and patients, encourage patients to be better informed, and improve the quality of information provided to patients. Relatively little empirical research has been performed in this area but what exists is generally supportive. Attention will need to be paid to issues of confidentiality, the language and content of letters, and individuals who may have difficulty obtaining information from letters. This initiative is one of many that the NHS has introduced to enhance openness, honesty and the quality of information provided to patients.     

Referral for minor mental illness: a qualitative study.

BACKGROUND: Mild depression and anxiety are common problems in general practice. They can be managed by the general practitioner (GP) alone or referred. Previous quantitative studies have shown a large variation between GPs in terms of referral behaviour. The reasons for this variation are not fully understood. AIM: To describe and analyse GP's decision-making processes when considering who should be treating patients with minor mental illness, using a qualitative method. DESIGN OF STUDY: A qualitative interview study. SETTING: Twenty-three GPs in east London and Essex. METHOD: Subjects were chosen using a purposive sampling strategy and participated in one-to-one semi-structured interviews. A grounded theory approach was used for analysis. RESULTS: Two distinct referral strategies were identified--the 'containment' and the 'conduit' approaches. In addition, referrals were found to be of two types--proactive 'referrals to' and reactive 'referrals away'; for minor mental illness the 'referrals away' were found to predominate. Emotive as well as rational responses informed GP decision making on referral. CONCLUSIONS: Explanations of the variation in referral rates need to recognise the emotive responses of individual GPs to minor mental illness. The contribution of guidelines, which assume consistently rational responses to illness, may therefore be limited.     

Responses to reprint requests: form letters versus preprinted cards

Nine hundred ninety-four reprint requests were made for almost all the original articles that appeared in five pediatric journals between August and October in 1985, 1986, and 1987. Half of the reprint requests were made with form letters and the other half with preprinted cards. A total of 636 (64%) reprints were received within 6 months of mailing the request. The return rates for reprints solicited by form letters and preprinted cards were 68% and 60%, respectively. The response to reprint requests was greater for more recent articles. The number of articles that came in the form of photocopies was directly proportional to the time interval between the publication and the reprint request. Forty-one requests (4.1%) were returned by the authors because their reprint supply was exhausted. Thirty-eight requests (3.8%) were returned undelivered. We conclude that letter requests solicit a slightly better response than card requests and that the response is greater for more recent articles.     

心理咨询师对会商与转介的心理观念误区研究

目的探讨心理咨询师在遇到不适于自己的来访者时,采取会商与转介的问题解决程序的现况、原因和正确理念。方法邀约广东省内35位心理咨询师进行的“专题—开放式”心理访谈。结果发现了4种典型的妨碍心理咨询师采取会商与转介行动的心理观念误区。结论形成了促进心理咨询师深入理解和积极接受会商和转介的学术观点。     

A follow-up study of the characteristics of dean's letters.

PURPOSE: To assess the content and quality of dean's letters since the publication of guidelines recommended by the Association of American Medical Colleges (AAMC) in 1989. METHOD: In 1998, the dean's letter writers at all 124 U.S. medical schools were surveyed. The questionnaire incorporated items from two previous surveys (1981 and 1992). In addition, samples of dean's letters (n = 451) from all U.S. medical schools for the graduating class of 1998 were rated based on the AAMC's guidelines. RESULTS: The response rate of the 1998 survey (66%) was lower than those of the two previous surveys (87% for 1992 and 85% for 1981). Schools that prepared letters that followed the AAMC's guidelines were somewhat more likely to have responded. According to the letter writers in 1998, close to 300,000 letters (approximately 1,050,000 pages total) were sent to residency directors, at an estimated cost of $26,000 per school. A total of 65% of schools produced adequate dean's letters based on the 1989 AAMC's guidelines, compared with 55% in 1992. Many schools were organizing the dean's letter in more readable formats, and more schools provided information that allowed for a comparison of students within the same school. CONCLUSION: The improvements in dean's letters are encouraging, but ten years after the AAMC's guidelines, 35% of U.S. schools still produce unacceptable letters. With the addition of the electronic submission of information, it is time to review further improvements to the dean's letter.