Sir, over the last few decades, the patient-clinician relationship has changed drastically. Today, the principle of patient autonomy has dawned as the dominant ethos in healthcare, markedly nullifying the previous paternalistic model. As a result of this radical swing of the pendulum, emphasis is placed on shared decision-making, and a greater responsibility is given to the patient in the management of their health. The importance of communication is being stressed more and more at undergraduate training, and different approaches to consultations are being taken by professionals to establish this. The implementation of guidelines to accredit this change in standard was formalised in the NHS Plan at the turn of the millennium: 'letters between clinicians about an individual patient's care will be copied to the patient as of right.'1

It was hoped that this change would come into effect by 2004, and as a result of the protocol, hospitals around the UK have set copying letters to patients as part of their guidelines. Previous literature seems to have proven that letter sharing is beneficial for patients; in 2003 The Department of Health funded 12 Pilot Projects, which showed that copying letters to patients improves communication between health care professionals.2 A review of previous literature in 2006 found that patients generally find copies of letters beneficial, and tend to be more satisfied with their consultation, whereas healthcare professionals are generally less keen to copy letters.3

A recent audit carried out in Barts and The Royal London NHS Trust found that 77% of patients wanted copies of their clinical letters. However, only 13% of the clinicians actually took consent to copy letters, with the main reason being that they forget to. From sitting in on multiple consultations in various specialties, the results of this audit do not seem to be a far cry from the reality in many hospital clinics.

It is understandable that a change in previous habits can be difficult to maintain after the administration of a new system. With the ever evolving clinician-patient relationship, all health professionals must be adept at adjusting to the reforming surroundings. This, in a field which rests heavily upon the importance of good communication; between not only the multi-disciplinary team involved in the care of the patient, but also between the clinician-patient relationship itself.