Letter

Frequent visitors of this site would know I try not to discuss topics directly related to clinical medicine. Nonetheless, I recently encounter a referral letter which I really found admirable.

Here you go:

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Doctor in charge

HA

Dear doctor in charge,

Re: XXX, Male / 61 Y

I would be grateful if you could see the above named patient with suspected OSAS and hypertension now noticed increasing malaise, on and off exertional chest discomfort and abdominal discomfort with change in bowel habit. Latest Ixs in private showed elevated creatinine Cr 105 (+ve history of kidney stone), alkaline phosphatase 74 & total bili 21, CEA 2.0. Ixs including sleep study, USG liver and kidneys, CT coro, colonoscopy may be considered in his condition.

Thank you again for your expert management.

Best regards, et cetera.

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(A reply letter that the malicious nephrologist decided to keep it for himself.)

Dear referring doctor,

Thanks for your referral. Given that almost every organ-system of this gentleman seems going wrong, and his family is very concerned about having multiple tests (even though they do not have to pay for all those), I believe the single gold standard investigation that we could solve all his mystery is an autopsy study.

Sincerely