Copying in or copping out?

I’m all in favour of health literate patients1—indeed, I see my role as helping patients understand what is happening to them and detailing the options so they can then choose what they want.

But I don’t copy my letters to them.

The purposes of clinic letters are to communicate with general practitioners and keep a legible record in the notes of what is happening and what might happen. It is written in medical speak, and it is fantasy to suggest that letters written like that will ever be meaningful, without further explanation, to most patients. So if I use those letters as a way of informing patients, I will need two letters—one for them, and one for the notes.

If I want my patients to know what is happening to them, it takes more than a letter. A motivated doctor who spends time in the clinic explaining things may well inform patients better than one who simply copies patients into all correspondence. And of course most of the research showing that copying in works will be done by enthusiasts who set out both to be informative in clinic and to copy letters.

I would be happy for patients to read their notes as they wait to see me so that they can easily and quickly ask about things they don’t understand. Some departments in our hospital automatically copy letters, and sometimes patients ask me to translate them when they come to my clinic.

In the era of target driven medicine, doctors compulsorily copying patients into correspondence could easily become a surrogate measure of patient centred care. Like many easily countable targets, this one would be a simplistic cop out that tells us nothing about what we really want to know.