1. CONSULTATION LETTER WRITING AND DICTATION AMBULATORY INTERNAL MEDICINE GROUP PRACTICE CLINIC Dr. Danny Panisko Updated by Katina Tzanetos Division of General Internal Medicine University Health Network and University of Toronto July 2007

2. References: l Writing effective consultation letters: 12 tips for teachers Erin Keely et al. Medical Teacher, Volume 24, No.6, pp. 585-589

3. CONSULTATION LETTER WRITING: OBJECTIVES FOR THIS LECTURE l Consider the role and characteristics of an ideal consultation letter l Read and critique sample consultation letters l Come to a consensus about the characteristics of an ideal consultation letter

4. CONSULTATION LETTER WRITING: ROLE OF THE CONSULTATION LETTER l Potential readers: Referring physician Consultant Patient Lawyers Insurance companies l Need to think about all of these individuals when dictating…but…. l Focus should be on needs of referring physician

5. ROLE OF THE CONSULTATION LETTER: NEEDS OF REFERRING PHYSICIAN l Important tool for facilitating ongoing care with Primary MD l Primary care MD often responsible for: Interpreting consultant’s opinion for patient Implementing diagnostic or therapeutic suggestions l Thus, letters should be received in timely fashion and have specific recommendations

6. ROLE OF THE CONSULTATION LETTER: NEEDS OF REFERRING PHYSICIAN l Consultation letters may also be used for Continuing Medical Education by referring physician l Survey in 1995 looking at what family mds wanted from letters Wanted guidance and education but rarely received this

7. ROLE OF THE CONSULTATION LETTER: NEEDS OF CONSULTANT l Often only detailed record of patient’s history, physical, and follow-up plan

8. CONSULTATION LETTER WRITING: Critique Sample Letters l 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

9. “Ideal” Letter l From the discussion, determine what your clinic’s letters will look like

10. CONSULT LETTER WRITING: For your information…from the literature l Most letters are read by family mds when they arrive in mail and again on the day the patient is being seen l Structured letters preferred over unstructured letters l Editing experts recommend using 1-4 headings/page l Appearance of headings should stand out l Use point form for items such as medications, pmhx, risk factors, and mgmt plan

11. CONSULT LETTER WRITING: For your information…from the literature l 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

12. CONSULTATION LETTER WRITING: Hints for successful dictation l Always identify yourself, the patient, and the date of the letter clearly l Leave your pager number in the dictation for the secretary so she can contact you if she has any questions l For the first few times, consider writing out in long hand before dictating into the machine l Experiment with and become used to all of the machine/system’s features

13. CONSULTATION LETTER WRITING: Hints for successful dictation l Speak slowly and enunciate clearly l Play back frequently to listen to yourself and make sure you are understandable and complete l Always seek out the transcribed copies of your dictations for your own feedback l Check how supervisors correct your dictations and always ask for feedback from them

14. CONSULT LETTER WRITING: l Apply your consensus on characteristics of an ideal consultation letter to dictations for the remainder of the year ! l GOOD LUCK !