• Anne Weiland, Annette H Blankenstein, Mariëtte H A Willems, Jan L C M Van Saase, Paul L A Van Daele, Henk T Van der Molen, Ginger B Langbroek, Aart Bootsma, Els M Vriens, Ardi Oberndorff-Klein Woolthuis, René M Vernhout, and Lidia R Arends.
• Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Faculty of Social Sciences, Institute of Psychology, Erasmus University Rotterdam, The Netherlands. Electronic address: info@anneweiland.nl.
• Patient Educ Couns. 2015 Oct 1; 98 (10): 1229-35.

ObjectiveTo evaluate effects of a communication training for specialists on the quality of their reply letters to general practitioners (GPs) about patients with medically unexplained physical symptoms (MUPS).MethodsBefore randomization, specialists included ≤3 MUPS patients in a multi-center cluster-randomized trial. In 14h of MUPS-specific communication training, 2.5h focused on reply letters. Letters were discussed with regard to reporting and answering GPs' referral questions and patients' questions, and to reporting findings, explaining MUPS with perpetuating factors and giving advice. After the training, all doctors again included ≤3 MUPS patients. Reply letters to GPs were assessed for quality and blindly rated on a digital scale.ResultsWe recruited 478 MUPS patients and 123 specialists; 80% of the doctors wrote ≥1 reply letters, 285 letters were assessed. Trained doctors reported (61% versus 37%, OR=2.55, F(1281)=6.60, p(group*time)=.01) and answered (63% versus 33%, OR=3.31, F(1281)=5.36, p(group*time)=.02) patients' questions more frequently than untrained doctors.ConclusionTraining improves reply letters with regard to patients' questions, but not with regard to the following: GPs' referral questions, somatic findings, additional testing, explaining, and advice.Practice ImplicationsTraining specialists to write appropriate reply letters needs more focus on explanation and advice.Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

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