Health Service Focus


Why don’t you write to your patients

Source: NHE Sep/Oct 17

The president of the Royal College of Surgeons (RCS), Professor Derek Alderson, talks about writing letters to patients with absolutely no ‘Surgspeak’ and the possibilities for advances in voice recognition technology to support this. NHE’s David Stevenson reports.

Advances in speech recognition technology are constantly being made, which could, eventually, lead to further benefits for the medical profession and the patients in their charge. Just before NHE went to press, for instance, Microsoft’s speech and dialogue research group revealed that its system had reached parity in conversational speech recognition. 

“Reaching human parity with an accuracy on par with humans has been a research goal for the last 25 years,” said Xuedong Huang, Technical Fellow at Microsoft. “Many research groups in industry and academia are doing great work in speech recognition, and our own work has greatly benefitted from the community’s overall progress. 

“While achieving a 5.1%-word error rate on the Switchboard speech recognition task is a significant achievement, the speech research community still has many challenges to address, such as achieving human levels of recognition in noisy environments with distant microphones, in recognising accented speech, or speaking styles and languages for which only limited training data is available.”

Moving from recognising to understanding speech is the next major frontier for speech technology, added Huang. 

In a recent article for the RCS’s magazine ‘The Bulletin’, Professor Derek Alderson, who was elected the organisation’s president earlier in the year, reflected on his career and whether surgeons do or don’t write letters to their patients summarising the outpatient consultation – especially after a recent meeting where he listened to a renal physician, who for more than a decade has been writing letters to those in his care. 

“I had tried this in my early consultant career in the dark ages of the electronic typewriter. The patients liked it, my secretary did not mind typing twice the number of clinic letters, but I grew to hate the need to check and sign all of these letters,” explained Prof Alderson. “There was also the small matter of letters sent by trainees on my behalf that always strayed heavily into ‘Surgspeak’. I convinced myself that most patients did not really care anyway, so when I asked them about the letter (I mainly asked those patients whom I thought would not have read it), I got the answer I was looking for. I gave it up as a waste of my time.” 

But as life moves on, and with the advent of the digital revolution, he asked the question: why don’t we follow up an outpatient consultation with a letter to the patient, summarising that consultation in a language the reader can understand? Especially as the General Medical Council states that patients must be given the information they want or need to know in a way they can understand. 

Prof Alderson explained that he had asked around to a number of surgeons who are sending letters to patients, and found that “patients like this behaviour.” 

“It makes them feel that they are being treated as individuals. It clarifies what was actually said in a consultation. Patients seem not to be frightened or upset by content. If they don’t have the capacity to read it then a carer or family member will read it to them,” he explained. “Having to turn medical language into a more colloquial style could be educationally beneficial and might help surgeons to convey technical information in a better way during consultations.” 

There are inevitable objections to this, he accepted, and although another letter involves extra dictation, “improvements in voice recognition technology might overcome additional demands on technical services and using email might overcome the cost of postage”. 

Although some solutions will lead to confidentiality dilemmas, the RCS president asked: does a patient’s happiness to be informed in this way not override objections? 

“For those surgeons who do write to their patients, I would like you to share your experiences and the feedback that you have received from patients,” he said. “If it’s a quality improvement then maybe it’s worth the investment in time.”



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