Why do hospital consultants write like this?

The other thing I noticed on the letter (in my original post) from the Consultant in a Reading Hospital was that it was posted from Adur District Council, West Sussex. Does that mean Councils hire out their secretarial services now to the NHS & recorded letters aren't sent to India anymore for typing? Does anyone know?

Many, many, many years ago, I was learning Pitman New Era shorthand (to go with the typewriting, of course). I still have the practise books for Medical Shorthand. Guess what phrase is used by the Consultant to the GP? Yes - you know it. That was the one about the "very pleasant lady". Although 6 years ago, the Consultant wrote to my GP and said "delightful 60 year old". Mind you, he wasn't English. So, I let him live. I don't think he knew the phrase... "I tell you and then I would have to kill you".

Anyone who receives any correspondence from consultants should count themselves very lucky. DH quite often refers patients to see a consultant but we only know any sort of outcome is when the patient rings and tells us they still haven't heard about an appointment - presumably the rest are seen and treated.

If DH mentions a 'lovely' patient it is because he thinks they are!

Health Centres (GP surgeries) still have "back office" workers, don't they? Ours certainly does (several) and it's only a two doctor practice. The letters I get (e.g. to remind me to go for a smear test) have certainly not been written by the GP. The practice nurses do the tests as well, also take blood, etc.

I think good secretaries and PA are/were invaluable. They didn't just take down whatever the boss said, they edited it and said what the boss should have said if he had the time to think about it. I knew a very highly paid man who would come back from a meeting which had gone badly and dictate to his PA. She would then type up what he had said and also another copy of what she thought he should have said if he had been calm. He invariably signed the second one! They knew how to construct a sentence, what to do with an apostrophe and how to organise just about everything. They knew who to allow to speak to the boss and who to keep away etc.

It was explained to me as the 'Mars Bar Economy'. If it cost 10 Mars bars for the boss to do a job but only one for the PA, then clearly it was better for the PA to do it.

Snap my consultant sad same it did not bother me!

What did upset me having lost stone (before cruise!)was his referring to my stomach being obese!

He did mention that I had lost weight but it rather spoilt it!

Wisewoman - I agree about the cost of doctors and other professionals typing their own letters/reports is difficult to quantify. I agree that typing a quick email takes no time, especially for those of us with typing skills. I don't expect that touch typing is taught at medical school, or on teaching/social work courses etc either. I have a background in working with offenders and children at risk. During the last few years I worked,our admin support was gradually eroded. Whereas I'd put a 40 page report on a tape, my secretary would type it, I'd amend and she'd finalise, I was left in the position of having to do reports myself. I have top typing speeds as I did a secretarial diploma when I left school, but even so, report writing along with completing endless forms on line began to dominate my working life. I think the latest research says social workers spend 70% of their time before a computer screen,so no wonder services to children and families are over stretched. Medical secretaries have always been a valued resource. I had a lovely letter from my consultant rheumatologist recently, thanking me for attending her post grad training day for GP's so they could try and formulate a diagnosis. I am quite sure Dr P didn't sit down and write to a group of us, her secretary would have been asked to write to a group of patients, and Dr P simply signed the letters. I'd hate to think of her time being taken up on admin, rather than looking after us. I also think it's be a shame of the friendly thank you letters became a thing of the past, because it's not cost effective.

Just managed to catch up with this thread after a day of "visiting the sick" yesterday.

Thank you all for your good wishes and kind thoughts. My grandma had a little bit to eat last night which is a step in the right direction and her "cheeky comments" are coming back so I am hopeful that she is getting a bit better. My grandmas GP is a lovely man and I really appreciate him talking to her the way he does and not talking through her, as though she is not there like many doctors seem to do with the elderly.

Going back to my first post. The letter my mums consultant wrote was so funny (she received a copy) as it mentioned the Sugar Free Strawberry Sweeties (M&S) I was handing out during a very hot and sticky consultation. the secretary must have had a giggle as she typed it out.

I think most medical notes, now noted quickly on the computer, take up less time to input than the old secretarial service. By the time the secretary had been called, entered the inner sanctum, sat down and the Great Man had stated which patient and dictated the notes and then later read them and made changes, a modern doctor has formulated his thoughts and typed them in a fraction of the time. Most of us, even though not touch typists, can, for example, type their GN posts quite quickly.

My husband, a Chartered Accountant, used to say the same thing wisewoman but over the years he has realised that putting things down straight from brain to paper has left less room for mistakes. He types at quite a competant 40 to 50wpm and his English is good so overall the end result is of good quality and efficient. I have to say I trained as a secretary and it does grieve me to have to admit this. Can still muster an adequate 70 to 80wpm with the wind behind me though AND I don't need to look at the keyboard. Beat that OH!

In these days when everyone uses a computer. secretaries are becoming more and more redundant. I wonder, however, if anyone has worked out the amount to time doctors spend typing when they could be seeing patients. Secretaries are paid much less per hour than doctors. In the "olden days" they also did so much of the admin work - organising diaries, meetings, preparing clinics etc. I don't think it is a more efficient use of time for doctors to be doing all these admin tasks.

Ah. I see. I think I was confused by the juxtaposition of that comment and the plain statement. More careful reading might have helped!

No Bags I mean the commenting on someone's personality is patronising "this charming lady" etc

jess, why do you think that sentence (I saw your patient, X, at my clinic) "patronising in the extreme"? Isn't it just a plain statement of fact?

gillybob, what a lovely story! Delightful to hear it.

Having moved around a fair bit in my life, I've had some passing experience of quite a few GPs (more than a dozen). Of those only one was a bit of a prat. The others have been ordinary straightforward people trying to do a good job and mostly not doing badly at all, though not perfect. Who is?

Luck? Hmm. Or maybe I'm just content with people doing their best and don't expect superhuman talents from people who, to all intents and purposes, might as well be my brother or sister (one of those is a GP).

Oh yes, like the teaching references referred on another thread "I commend this candidate for your consideration" = lousy candidate I'm afraid.

Just a thought - and apologies if it has been said somewhere already. This reminds me of the importance of what is left out of references. So when the consultant does not say "delightful, charming, pleasant" etc he is in fact saying "cranky, time-wasting, hypochondriacal, irritating, nuisance" etc. Sobering thought!

LizG ICE is short for In Case of Emergency.

If you were to meet with an accident and be unable to tell paramedics who to contact, they would look in your handbag for addresses or phone numbers of your family to tell them what had happened. They (the paramedics) are very pleased if they find that you have added "ICE" to the names of those people you would like to be informed.

When I heard this I tagged my family on both mobile and house phone.

But how many patients would not be seen if the consultant had to sit down and type up the notes. In my day the secretaries did audio typing .how many jobs lost if there were no medical secretaries? I don't ask the plumber to sort out my tax returns so I'd want the consultant I had consulted to give me his considered opinion and the secretary to make sure it got Barack to the GP. On line is open to a any passing hacker.

Aka... a bit sad this after 9+ year of study (:

DD's registrar is a female doctor about the same age as her and the two of them get on like a house on fire, probably the shared Irish genes, (or is that racist!). She described DD as this 'delightful lady' in a letter to her GP so I do not see how the phrase, certainly in her case, can be either sexist or condescending.

DD gets a copy of every letter sent out to her GP or anyone else involved in her treatment, including internal memos (as we used to say) from the doctor who sees her in the clinic to the consultant when, as this week, there was a detailed discussion about the options for the next stage of her treatment.

I suspect that now that patients can see all their notes doctors have reversed the system 'delightful lady' means a patient we can work with 'this lady' means a bit difficult to deal with and 'this patient' means really diificult, doesnt take medication regularly and ignores our advice.

Dictation skills course needed charleygirl?
Quite movalot - cost of posting a letter let alone the time taken to dictate and then get typed. Maybe when the kind of software that you just talk to and it turns into text gets a bit more slick, they will just go straight to that and see their deathless prose appear in type before their eyes

The orthopaedic hospital that I attend get the letters typed in India. On the whole they are well typed. I always receive a copy but it irritated me a few months ago when I read the long post op letter as it mentioned my name on nearly every line and sometimes twice in the same sentence.

Why are they still writing letters? Why not emails? Quicker and cheaper imo.

I expressed surprise to my physio when he said he was going to write a letter to my GP and suggested email and he looked as if no one had thought of it before. He then said it didn't cost anything as it went in the NHS post! Paper, envelope, fuel.....................

Yes it is Gillybob perhaps it's time for patients to fight back. I'd describe one of our GPs as DoK HAF HE...Doesn't Know His Arse From His Elbow