In message <03b301c42e11$840fb480$0207a8c0@study>, Trefor Roscoe
<[log in to unmask]> writes

>
>Not iffy.
>
>No one knows what the average referral contains and how useful the
>narrative, rather than just a box ticking programme is.

Shouldn't you start at the other end and decide what it is that is
useful to the person receiving the referral, rather than looking at an
archive of mixed referrals, written for different purposes to different
specialities?

>
>I need to see if the average letter is packed full of info, what it does
>have and what it leaves out.

Well, in my case there are things that are almost standard: statement of
the problem I want investigated or managed. (This may or may not be a
diagnosis. ) Medication. Allergies (both imported) PMH significant to
the condition or potential treatment of that condition. Any relevant
family history. Bits of social history where relevant - smoking and
alcohol status and history; occupational history; whether exposed to
birds, loud noise, etc.; travel; living conditions.
The amount of narrative attached depends on the problem. E.g. a new
breast lump would probably fit onto one side of A4 and include when
found, previous breast history or lack of it, FH Ca breast or lack of
it, examination , medication especially HRT or OCP, allergies, other
medical conditions and possibly some comment on mental state if
relevant.
An undiagnosed complex medical condition would need to include a lot
more, including possibly occupational and travel history, attempted
treatments and responses, investigations done and results, and my and
the patient's views on possible diagnoses.

How *long* this would be would depend partly on the audience being
addressed, partly on what needed to be included, and partly on my prose
style.

There is a huge variation in my sample of 1: would knowledge of the
average help to design the ideal?
>
>Only then will one be able to advise on the exact nature of what should
>be in the e-referrals.

Sorry, knowledge of content of past referrals, without knowing how
useful the recipients found them , is unlikely to help here!

>
>Getting a simple proforma for colorectal referrals took months.

The information needed in a colorectal referral - indeed any referrals
for specific conditions - is relatively straightforward: can they be
used as a model for *all* e-referrals?
There are *some* elements which might be standard - reason for referral,
medication, allergies - and some which need to be recorded automatically
- smoking for chest clinics for instance.
Even then, would you need to have 3 possibilities? Yes/No/Not recorded?

>
>I agree though that the data protection act scuppers this sort of
>research.

Back to the drawing-board?

MaryH

PS has any work been done from the other end? What do recipients of
referral letters consider to be of most use?
--
Mary Hawking