CONSULTATION LETTER WRITING AND DICTATION

AMBULATORY INTERNAL MEDICINE GROUP PRACTICE CLINIC

Dr. Danny PaniskoUpdated by Katina Tzanetos

Division of General Internal MedicineUniversity Health Network and University of Toronto

July 2007

References:

Writing effective consultation letters: 12 tips for teachers• Erin Keely et al. Medical Teacher,

Volume 24, No.6, pp. 585-589

CONSULTATION LETTER WRITING:OBJECTIVES FOR THIS LECTURE

Consider the role and characteristics of an ideal consultation letter

Read and critique sample consultation letters Come to a consensus about the characteristics

of an ideal consultation letter

CONSULTATION LETTER WRITING:ROLE OF THE CONSULTATION LETTER

Potential readers: • Referring physician• Consultant• Patient• Lawyers• Insurance companies

Need to think about all of these individuals when dictating…but….

Focus should be on needs of referring physician

ROLE OF THE CONSULTATION LETTER: NEEDS OF REFERRING PHYSICIAN

Important tool for facilitating ongoing care with Primary MD

Primary care MD often responsible for:• Interpreting consultant’s opinion for patient• Implementing diagnostic or therapeutic suggestions

Thus, letters should be received in timely fashion and have specific recommendations

ROLE OF THE CONSULTATION LETTER: NEEDS OF REFERRING PHYSICIAN

Consultation letters may also be used for Continuing Medical Education by referring physician

Survey in 1995 looking at what family mds wanted from letters• Wanted guidance and education but rarely

received this

ROLE OF THE CONSULTATION LETTER: NEEDS OF CONSULTANT

Often only detailed record of patient’s history, physical, and follow-up plan

CONSULTATION LETTER WRITING: Critique Sample Letters

Consider discussing the following characteristics of samples provided:• Length• Content (new patients and f/u)• Format (hx, px…)• Use of Headings• Use of Typographical emphasis (bold or italic)• Use of Abbreviations• Report of Investigations• Recommendations• Physician Education

“Ideal” Letter

From the discussion, determine what your clinic’s letters will look like

CONSULT LETTER WRITING:For your information…from the

literature

Most letters are read by family mds when they arrive in mail and again on the day the patient is being seen

Structured letters preferred over unstructured letters

Editing experts recommend using 1-4 headings/page

Appearance of headings should stand out Use point form for items such as medications,

pmhx, risk factors, and mgmt plan

CONSULT LETTER WRITING:For your information…from the

literature

Three surveys showed that “essential content” of a letter included: • Study one (primary care and specialists referred by a

single oncologist): • diagnosis, findings, test results, further tests, treatment

options and recommendations, benefits and risks of treatment

• Study two (child psychiatry referrals): • treatment and plan, specialist’s understanding of

problem, diagnosis, what parents were told and date • Study three (primary care physicians and

specialists): • impression, plan, investigations to be done and by

whom, medication changes were among top 4

CONSULTATION LETTER WRITING:Hints for successful dictation

Always identify yourself, the patient, and the date of the letter clearly

Leave your pager number in the dictation for the secretary so she can contact you if she has any questions

For the first few times, consider writing out in long hand before dictating into the machine

Experiment with and become used to all of the machine/system’s features

CONSULTATION LETTER WRITING:Hints for successful dictation

Speak slowly and enunciate clearly

Play back frequently to listen to yourself and make sure you are understandable and complete

Always seek out the transcribed copies of your dictations for your own feedback

Check how supervisors correct your dictations and always ask for feedback from them

CONSULT LETTER WRITING:

Apply your consensus on characteristics of an ideal consultation letter to dictations for the remainder of the year !

GOOD LUCK !