Patient Correspondence Letter 2

This is an example of a letter I wrote on behalf of a fellow general ophthalmologist, my practice colleague, for his patient. The patient, a young woman, was found to have papilledema during a routine eye exam.  For any non-MD readers of my blog, papilledema describes a condition of bilateral swollen optic nerves as a result of increased intracranial pressure. This is a dangerous condition that if left untreated has very negative implications on not only the patient’s sight but on the patient’s life. As a result of this finding, she was promptly referred to a neurologist for the appropriate testing and management. Unfortunately, the patient never kept the neurology appointment and the administrative staff  made the referring ophthalmologist aware of this.

In these cases, it is very important to reach out to the patient and explain, once again, the importance of following up with the treatment and management of such conditions. The patient here needed to understand that her eyes—and her health—were at grave risk.

When sending such correspondence letters, the communication should be done in a language the patient understands. As this patient was Spanish-speaking with limited English proficiency, this letter was written in Spanish plain language (aka non-technical Spanish language).  For purposes of this blog entry, I have provided a translation of the letter in English as well.

*names have been changed for privacy purposes

Estimada Sra. Méndez*:

Recibí recientemente un informe de la Dra. Smith*, la neuróloga.  La carta me informó que usted se suponía tener una cita de revisión con ella después del examen conmigo, pero le faltó la cita.  Usted recuerda nuestra conversación durante su examen aquí, cuando le dije que usted tiene nervios ópticos bien inflamados y hinchados.  Esto significa que usted tiene alta presión dentro del cráneo y necesita más pruebas por la neuróloga (incluye una punción lumbar) y medicamentos para tratar y curar esta condición.

También, la Dra. Smith me dijo que usted no ha recogido de la farmacia las pastillas que ella le recetó. Ella me dijo que ella ha tratado llamarla muchas veces, pero no podía contactar a usted.

Esta presión que tiene en el cerebro es muy peligrosa para su salud y la salud de sus nervios ópticos.  Si no recibe el tratamiento para bajar la presión del cráneo, puede quedar ciega por esta condición.  Por favor, le ruego que llame usted la oficina de la neuróloga inmediatamente cuando recibe esta carta, para hacer el examen de la espina y la punción lumbar y también, le solicito que recoja los medicamentos de la farmacia.

Después de que empieza usted el medicamento y tiene el examen de la espina, necesita regresar aquí por otro campo visual para hacer un examen de seguimiento de los nervios ópticos. Si tiene preguntas, llame esta oficina en cualquier momento. Si nos necesita para hacer la cita para usted con la neuróloga, nos complace hacer esto para usted.

Gracias por su paciencia y atención en este sentido. Recuerda, la salud de los ojos y del cuerpo están en juego.

Sinceramente,

Dr. Johnson  

                                                                        *

Dear Mrs. Méndez:

Recently I received a report from Dr. Smith, the neurologist.  The letter informed me that you were supposed to have a follow-up appointment with her after your exam with me, but you missed that appointment.  You remember our conversation during your exam here, when I told you that you have very inflamed and swollen optic nerves.  This means that you have elevated pressure inside your head and you need more tests by the neurologist (including a lumbar puncture) and medication to treat and correct this condition.

Also, Dr. Smith told me that you have not yet picked up the tablets from the pharmacy that she prescribed for you. She told me that she has tried many times to call you, but has been unable to contact you.

This pressure that you have inside your head is very dangerous for your health and the health of your optic nerves.  If you do not receive treatment to lower this pressure, you can become blind from this condition.  Please, I ask you to call the neurologist’s office immediately when you receive this letter, to have the spinal exam and lumbar puncture, and I ask that you also pick up the medications from your pharmacy.

After you begin the medication and you have your spinal exam, you need to return here for another visual field test to follow up on the optic nerves.  If you have questions, call this office at any time. If you need us to make the appointment with the neurologist for you, it would give us pleasure to do so.

Thank you for your patience and attention in this matter.  Remember, the health of your eyes and your body are at stake.

Sincerely,

Dr. Johnson

The Eye Exam 2017