Long life

Why do consultants write such scary, incomprehensible letters?

The patient knows very well what the symptoms are; so does the GP. That doesn't mean they can understand the description of them

24 May 2014

9:00 AM

24 May 2014

9:00 AM

There is a kind of letter designed to bewilder, upset and possibly terrify its recipient, and this is the standard letter sent by specialist medical consultants to the victims of disease. Actually, the letter is usually addressed to the sufferer’s GP, but a copy is always sent to the patient as well; and because of this it usually begins with a flattering personal reference just to soften him up (‘It was a delight to meet this charming old gentleman’, or some such phrase). Thereafter, it may propose some little variation in the person’s treatment, but its main purpose is to describe in lurid and impenetrable detail the symptoms of his disease. Of course, the patient knows very well what those symptoms are, as does his GP; but the consultant seeks to describe them with words that no ordinary person can understand but that provide reassuring evidence of his scholarship in his chosen field.

I have written before about my elder brother John, who lives next door to me in Northamptonshire, and about his Parkinson’s disease. This is a disease that affects people in different ways, but in John’s case its only major impact is on his mobility. He finds it hard to get in and out of chairs, and he walks with difficulty, but in most other respects he is in rather good shape for someone who is soon to be 87 years old; his mind, in particular, functions very well. Still, every now and then he likes to have a check-up with a Parkinsonian specialist, and recently I took him to see one in hospital. I waited outside the room during the consultation, and afterwards John asked the specialist to brief me, his brother, about his condition. No need, she said, for all would be made clear in the letter she was going to send.

The letter duly arrived, and this is what it said: ‘He had quite a stooped posture on walking and some gait freezing on turning and getting started. There were five steps of retropulsion on the pull test giving him a Hoehn and Yahr score of 3.0. He had a fine rest tremor of both hands. There was only mild cogwheeling rigidity at both wrists and mild bradykinesia with decrement of repetitive movements in the left arm and foot. He is on an even keel during the day with no wearing off periods, or dyskinetic movements. All things considered, his Parkinson’s is reasonably well controlled.’

I began to wonder whether the GP, to whom the letter was addressed, would even know what ‘retropulsion’ meant (‘Transference of an external disease to some internal part or organ’, according to the OED), let alone ‘gait freezing’ or any of the fancier words. As for ‘cogwheeling’, whatever it is, the OED doesn’t recognise ‘cogwheel’ as a verb. Maybe a clever GP would get the hang of all this, but it means nothing to me; and more importantly it means nothing to my brother, the person struggling with Parkinson’s and hungry for information about his condition and prospects.

I still have a copy of a letter written 16 years ago by a dermatologist whom John had consulted about a lump that had developed on his left leg after too much sunbathing in the West Indies. It began by thanking his GP ‘for explaining his past history of lues, urethral stricture, cervical spondylosis, skull fracture with resultant anosmia, hay fever, Dupytren’s contracture, and recent glycosuria’. In addition, the dermatologist had identified ‘many solar lentigoes’, ‘some seborrhoeic warts’, ‘rosaceous telangiectasia and milia of the cheeks’, ‘fibroepithelial polyp of the nape of the neck’, ‘a viral wart’, ‘sebaceous cysts’, ‘psoriasis of the fingernails’, ‘tinea cruris et unguium’, and ‘slowly progressive androgenic alopecia’.

I remember how dejected my brother was after reading this letter, just as now he is feeling less than elated by the letter from the Parkinson’s consultant. These specialists seem eager to pile up as much evidence of decrepitude as they can possibly find, and to cloak it in language that eludes comprehension and gives no idea of its gravity or otherwise. And maybe what has so far been revealed is just the tip of an iceberg, and that further examinations by further specialists would uncover much more. Still it is already quite comforting to know that someone can suffer for decades from a host of evil-sounding ailments and still be cheerfully preparing to celebrate his 87th birthday. John asked the specialist if his Parkinson’s might shorten his life, and the reply came that there was no way of telling but that he seemed to have been alive for quite a decent amount of time already.

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  • Retired Nurse

    If its any consolation, most GPs don’t understand a word of these letters either.
    Horrifying experience with a relative who’d been misdiagnosed with cancer, due to the cretins now working as ‘Consultants’ at some NHS Hospitals. They’d diagnosed ‘lumps ‘ on a standard CT scan as ‘cancers’ and ‘metastases’ – despite the fact it this impossible without taking biopsies. No ‘contrast enhancement’ to give them a better indication either. The ‘metastases’ meant they werent obliged to give any surgery or radiotherapy.

    I though his GP might be able to help us as he was named as one of the ‘experts’ consulted for the relevant NICE guideline – which stated quite clearly (bold and italicised) that biopsies are the ‘gold standard’ for diagnosis, and that you simply cannot diagnose from a CT scan without a biopsy.

    Sadly, he was a complete arse who it transpired didn’t even understand what figures in his TNM status stood for himself !