Mariken Stegmann

radiologist or pathologist was given without description of their implications for diagnosis or  treatment. Many letters also mentioned the potential side effects of proposed or given  treatment. In some letters, specific recommendations were given to the GP about how to  handle side effects, but in others, either a simple reference to a protocol or guideline was  provided, or no recommendations were mentioned (e.g. Q4). Late effects were almost never  mentioned.  Q4: The surgical operation, the expected course, but also the complications related  to the treatment, were discussed with her.  Specialist letter – policy. (Small non‐academic hospital, colorectal cancer, Doc6)  Although many letters reported that information was shared with the patient, this was not  very specific in most cases. The emotional reaction of the patient to receiving specific  information was seldom reported (e.g. Q5). In the interviews, GPs mentioned that they  would like to receive information about what was discussed with the patient regarding  treatment and prognosis.  Q5: Patient and daughter are very relieved that we did not opt for chemotherapy;  they agree with the therapy proposed.  Specialist letter ‐ policy. (Academic hospital, breast cancer, Doc50)  Both referral and specialists’ letters   Abbreviations were used in all letters. Most were common medical abbreviations (e.g. Q6),  but some were department‐specific (e.g. Q7). In the interviews, GPs mentioned that they did  not understand all abbreviations that were used, and some medical specialists stated that  they tried to avoid abbreviations and department‐specific terms whenever possible (e.g.  Q8).  Q6: Cor ne, pulm vbs, abd nca, shoulder limited mobility. Full version: Cor normal  examination, pulmones vesicular breathing sounds, abdomen no clear abnormalities,  shoulder limited mobility.  Referral letter – physical examination. (Lung cancer, Doc17)  Q7: During positioning of PCEA, patient developed AF, for possible post‐surgical  anticoagulation PCEA abandoned. After resection ICG‐clearance 8%.   Specialist letter – surgery report (Academic hospital, colorectal cancer, Doc6)  Full version: During positioning of patient‐controlled epidural analgesia, the patient  developed atrial fibrillation. For possible post‐surgical anticoagulation, patient‐ controlled epidural analgesia was abandoned. After resection, the indocyanine‐green  clearance was 8%.  Q8: I really try to avoid using abbreviations, since knowing all different abbreviations  by all different specialisations is not doable for a general practitioner.  Interview of specialist nurse (Academic hospital, breast cancer, I3)  72 Chapter 6