Psychiatric referrals within the hospital--the communication process.

This two part study examined the written communication between psychiatrists and other hospital doctors. In the first part a set of sample letters from a psychiatrist, who had seen a ward referral, was sent to 110 physicians and surgeons. Nearly half expressed a preference for a psychiatrist's letter that was one page long with main points underlined. Clarity of psychiatric diagnosis and opinion and clear treatment/follow-up arrangements were the key items of content. In the second part 100 consecutive referral letters and their replies were assessed; 20% of referral letters did not express the precise reason why psychiatric opinion was sought and many of the psychiatrists' replies did not describe adequately the follow-up arrangements and prognosis. In general the psychiatrist found the referral letters short and lacking in information whereas referring doctors found the brief replies from the psychiatrists preferable because the brief letters contained the key items mentioned in the first part of the study. In addition to these recommendations regarding written communications, this study emphasizes the need for personal discussion between psychiatrists and other hospital doctors; nearly half the doctors in the first part of the study thought this would be essential for good management of the patient.