Improving correspondence to general practitioners regarding patients attending the ENT emergency clinic: a regional general practitioner survey and audit

Introduction:The ENT emergency clinic provides an important out-patient service; however, often, no correspondence is sent to the general practitioner.Aim:To conduct a general practitioner questionnaire audit in order to assess whether a standardised, computerised clinic letter template could improve communication between the ENT emergency clinic and patients' general practitioners.Standard:All ENT emergency clinic patients should have a summary letter sent to their general practitioner.Methods:One hundred general practitioner questionnaires were enclosed with the first 100 ENT emergency clinic template letters sent to patients' general practitioners.Results:Seventy-two general practitioners responded (72 per cent). Of these respondents, only 7 per cent had previously received regular correspondence from the ENT emergency clinic before the introduction of the computerised letter template. Following its implementation, such a letter was sent to 100 per cent of the clinic patients' general practitioners. Ninety-seven per cent of the general practitioners valued the template letter, with a mean satisfaction score of 8.4 on a 10-point scale. Eighty-six per cent of the general practitioners stated that they would not prefer a dictated letter.Conclusion:The introduction of a simple, computerised clinic letter template improves communication with ENT emergency clinic patients' general practitioners.

Reducing the costs of chronic somatisation

We report the case of a 48 year old woman who presents with a 25 year history of somatisation disorder. She has ten volumes of notes from four hospitals in one city which together weigh almost 10kg. She has been under the care of ten hospital specialities, had eleven operations, with 77 admissions and a total of 856 days in hospital over a period of twenty-five years. No physical diagnoses can satisfactorily explain her presentations which have been accurately costed to a total of over £250,000 as a conservative estimate.Somatisation disorder is a chronic illness with financial, medical and personal costs. We report in detail recurrent dangers and pitfalls which arose during her hospital contact. By undertaking a case note review, contacting all the physicians involved and writing a “Key” summary letter outlining the contribution of psychological factors to her problems, her annual health care costs were reduced from a total of over £10,000 a year to a little over £2,000 after psychiatric intervention and the appointment of one physician to take overall charge of her case. Implications for service provision are discussed.