Orthopedic departments across the country are being overwhelmed by the ever increasing amount of trauma work. This directly translates into larger and busier fracture clinics. About 25% of a clinic session is spent dictating letters to General Practitioners. This combined with the secretarial work, mailing process and filing puts considerable demands on manpower and resources. The standard 10 working day rule may not apply to fracture patients as many of them are seen on a weekly basis. General Practitioners form the backbone of the NHS in Scotland. One cannot overly stress the importance in keeping GPs up to date and informed about their patients as they are called upon to give advice out of hours and also to liaise with other specialties.
We conducted a questionnaire survey of all GPs in South Lanarkshire(65), to asses their views regarding the correspondence they received from the orthopedic department at Wishaw General Hospital. The points raised were1) Do fracture clinic letters reach on time or were they late.2) Were the contents of the letter satisfactory or not. 3) Was the orthopedic terminology used clear or confusing.4) How often did GPs want letters from the clinic i- At every visit. ii- At start and end of treatment only iii- Only when significant changes to treatment are made. The GPs were also requested to make any other suggestions they felt may improve our service.
The response rate was encouraging with over 70 % reply. 57 % of the respondents indicated that they felt clinic letters reached them late.94% were happy with the contents of the letter, and felt they contained sufficient information.15 % remarked that the letters contained too much Orthopedic terminology like fracture classifications and trade-names of implants which were not helpful. 50 % of the GPs surveyed, felt it appropriate that a letter is send out to them at every clinic visit.7% wanted correspondence only at the start and end of each treatment episode.28 % indicated that they expected communication only when significant changes to treatment programme are made.15 % of the respondents preferred letters to be send out to them at the start and end of treatment, and also when any change to treatment plan is made.
Many of the GPs suggested that the way forward would be to either e-mail or fax the letters avoiding delay and lowering costs. Other suggestions included the use of a standard format or performa for the letters rather than the narrative style in use currently, to save secretarial time and to ensure that sufficient relevant information is included. A major complaint was that most letters never had a clear management plan explained , which made it difficult for the GPs to advise patient’s employers, and to issue leave notes. This also affected their talking to lawyers and insurance companies.
Communication and teamwork are essential for success in any discipline. As doctors we are encouraged to communicate better with our patients, but we seem to have forgotten the importance of talking to each other. Every effort should be made by both hospital practitioners and general practitioners to try and communicate in one language to provide the best possible care for our patients and to ensure that no further delay in treatment occurs more than the waiting times that we are already struggling to reduce.
Although the survey was limited to one department and general practitioners in one region, we feel that the results may be representative of the practice in other regions of Scotland also. The feedback obtained from this survey will hopefully help us to improve our service and allow optimization of resources leading to better patient care.
ANAND PILLAI .MS, MRCS - Aorthopod@aol.com
SAMI ATIYA. FRCS- smatiya@aol.com
June 2003
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