Writing Letters of Support – How Far is Too Far?

Patients know doctors are held in high esteem, so they often turn to their doctor for letters of support.

When should I say yes?

It is appropriate to write a letter of support when the information the patient is seeking is entirely factual and within your area of knowledge and/or expertise.

When should I say no?

If a doctor calls MDA National to seek advice about whether to write a letter of support, invariably the alarms bells have already started ringing. If it feels a step too far, it probably is.

Letters of support which require you to make a moral judgement, or interfere with an existing court order, should be considered carefully.

If you speculate or advocate without the benefit of all the facts, your own integrity may be called into question.

Case history

John is a new patient to the practice. At the first consultation, John seeks repeat scripts for Panadeine Forte and Endep. He presents a letter from his previous GP referring to chronic leg pain following a motorcycle accident three years prior.

The next time John comes in, he asks Dr Jones to write him a letter for court. He hands over a letter from his lawyer which says:

Dear Dr Jones

We understand you are treating our client for injuries suffered in a motorcycle accident in 2013.

Our client has been charged with stealing a motor vehicle, dangerous driving, and possession of methamphetamine.

He intends to mitigate his guilty plea on the basis that he has difficulty understanding the consequences of his actions since the accident.

Can you please write a letter “to whom it may concern” confirming that our client is of good character, and that his behaviour is the result of head injuries from the motorcycle accident and the medication he is taking to treat those injuries.

Yours sincerely…

Medico-legal issues

There are a number of reasons why Dr Jones should not comply with the lawyer’s request:

• He has only met John twice and therefore cannot comment on his character, either before or after the motorcycle accident.
• The patient has been treated by other doctors in the period between the accident and the move to Dr Jones’ practice, so Dr Jones has no clinical information about an alleged head injury.
• There is no clinical evidence to suggest that Panadeine Forte or Endep would influence the patient’s behaviour to the extent alleged.
• He avoids writing letters “to whom it may concern” as he has no way of knowing how the letter will be used.

Dr Jones is not obliged to provide the letter requested, and instead writes:

Dear Sirs

I have consulted John Smith on two occasions – 21 October and 1 November 2016.

On 21 October 2016, John provided me with a letter from his previous GP noting ongoing leg pain from a motorcycle accident in 2013.

John advised me his leg symptoms remain unchanged and I provided repeat scripts for the following medication:

• Panadeine Forte
• Endep.

Yours sincerely…

If you receive a request for a letter of support and you are unsure how to respond, contact our Medico-legal Advisory Service for guidance on 1800 011 255.

Nerissa Ferrie
Medico-legal Adviser
MDA National

References

1. Medical Board of Australia. Doctors the Most Trusted Professions: Board Research. Available at: medicalboard.gov.au/News/2016-11-10-media-statement.aspx