Copy letter to child ?from what age

[dratsea]

Hi all, this follows on from a question I asked on another thread. It is now standard practice to copy all communications to patient/parent, and I did this for many years. But I would address the copy letter direct to the child if "age appropriate". It is the child having treatment, they respond well to being spoken to and not about and most parents get this. But not all, and it surprised me how often I got into trouble for doing so. I have now retired and this is out of curiosity.

As I said, I have asked this elsewhere, did not want to hijack the thread on AIBU and would welcome any responses.

I would expect all medical letters for an U18 to come addressed to the parent guardian of....., not directly to the child.
So, 18 would be my answer.

I would expect all correspondence up to 16 to be addressed to the parents ,16-18 is a bit of a grey area .

Agree with Floralnomad.
An alternative would be a letter intended for the parent and another for the child with the child's version containing age appropriate detail.

I would say 16

enderwoman tbh letter to GP usually really boring like:

"Thank you for kind referral of Boris, age 14. He does indeed have a small indirect right inguinal hernia, it is causing no symptoms and he would like to wait until after GCSE exams for surgery. We have arranged provisional date of 2nd June. Boris will ask his parents to contact me should it become painful and he would prefer an earlier date."

Now: In opd I sat Boris next to me , asked him what the problem was, asked him if he wanted mum to come behind curtains while I examined him (full open eye horror - no!) and got him to sign consent form and apologise that as he is under 18 would he mind if I get mum to countersign.

And I send copy GP letter to "parent of"? Not so doing did get me in trouble but I am unrepentant!

You asked Boris if he would mind his mum counter signing but the bottom line is if he had said yes he minded you would have been stuck because you would not have been able to operate without his parent/ guardian signing the form . Quite honestly it all seems a bit ridiculous to me and as if you are trying to make a point which doesn't need making , most doctors speak to the child but ultimately the parent is responsible .

i woudl say 16

Floranomad I have, legally, operated on many children under the age of 16 without a countersignature from a parent. I refuse to operate (non urgently) on any competent child on the basis of faxed signature from SS. They have to be there to hear what I say to child and are left to discuss together before I come back and see if child wants the operation and only after the child signs do I get very junior representative of council to countersign. And please do not get me started on parents caring for over 18yr old insisting it is their choice what to do for their child. Their views are important but not legally enforceable. There remains an anomaly for the competent under 18yr who does not want treatment and the parents insist. If urgent, and appropriate, I could have got a decision fairly quickly, but never had to do so.

My children are 15 and 16 and I would expect the consultant to address them primarily rather than me/dh, and for them to fundamentally make the decision regarding treatment. I'd be surprised but really pleased if the follow up letter was addressed to them.

dd is in a clinical trial at the moment (follow up to her HPV vaccine, will involve her doing at home smears for I think 10 years). She decided to enter it and all the correspondence comes to her.

At 14 Boris would probably have been judged Gillick competent wouldn't he?

Dd is 17 all her hospital letters are parent/ guardian. She is under a childrens hospital though.

nooka thank you for your post, I was beginning to think I should be reporting my thread and ask for it to go back to AIBU!

My honest answer is I don't know. I think the parents definitely need a letter until the child is 16-18, and presumably Drs don't want to be writing another letter. Ds has had some troublesome issues this year. He is 11. I have his correspondence and I have shared parts of it with him. However he is in denial - maybe it would be helpful for him to have his own version of some of the letters (definitely not appointment letters for tests as they would have made him worry).
With regards to tests and procedures that he's been through, I was quite happy to just be an observer in the room, only stepping in when I could see that he needed emotional support or that he didn't understand something that was being asked.

I would say actually 18 is an adult.
but some doctors/departments may have 16 as their policy.

as regards to being in the clinic itself, i imagine most doctors are pretty sensitive

my 16 year old could go to the doctor on her own,

some doctors may well get around this by addressing the letter to both, which seems very sensible

eaasterlywinds I think the youngest to whom I have addressed the letter was 13, and as to greeting my patients, I started at about age 5 but realistically do not expect to get a response re symptoms and reason in the hospital until about age your ds. Oddly (?) emergency cases probably a bit younger. And most boys, at least in opd, would be a bit older to respond with reason they have come to see me.

But interesting responses here, and wish I were on MN tears ago and I think that so far it is clear more of the parents agree with my initial approach to patient than to my addressing the copy of the letter to GP to patient rather than parent.

Noah, exactly right about 18 rather than 16 as age of majority but we struggle with 17 yr olds in hospital usually excluded from the paediatric wards. Ward sister asked nicely has admitted 16 yr olds doing GCSE on ward to have teachers on hand and also handicapped young adults up to age 20 on her ward. We spent 15 yrs pushing for an adolescent ward, either 14-18 or 16-20 to include those with handicap (or diabetes, very different for 20 yr old compared with real adult) both age ranges have clear claim for their own places in a hospital. And I would have been delighted to see your dd without you but I would have asked her that I could copy the GP letter to both of you, and no doubt she would have been amazed that I felt I had to ask.

You simply need to add 'I assessed Boris competent, and will be proceeding on the basis of his own consent. All patient information letters will accordingly be going straight to him"

Ask if there's specific verbiage in your trust area. Or colleagues in family planning, termination or GUM services what they do.

*scaevola" thanks, that is what I wrote in the notes, still got hassled.

But yes, should have escalated to fp and gum but might have been viewed as dissing my managers. I have a thick skin, many of my patients did not.

I think the paediatricians who have most impressed me, are the ones that greet me and ds, chat to ds for a bit about why he's there and then ask him if it's okay to chat with me. So they're acknowledging him and treating him in a grown-up way but getting the nitty gritty from me. In fact, one of the Drs asked ds if he had any other questions and the main one was because ds felt that I was hiding things from him.

I'd not be terribly bothered if the letter come to me or my DD's. I'd be horrified if I thought you'd be referring to my DD with MLD as 'handicapped', though. It's a word that should never be heard again, save for educationally to demonstrate how far society has come.

I don't remember my parents getting copies of the letters from my consultant when I was a child. But what I do remember was everytime I saw him (and I saw him from babyhood until I was 16 at least once a year) he'd ask how I thought I was getting on. I didn't always know what to say but he always asked and gave me time to answer. Friends who have the same condition mostly saw another consultant who didn't do that.

What I didn't appreciate was when as a 15 year old I was offered surgery and my parents declined on my behalf (after a year of waiting to see what happened, second opinions and having had a discussion and letting me choose as it had crap odds of working) having my next appt need to be much sooner than usual and magically the only date available was 2 days after I turned 16. Being greeted with "Hope you had a good birthday, now you're 16 you can sign consent forms so now you can decide if you want surgery, do you?" was rubbish.

Honestly? I don't think my dc are at all interested in the letters I've received. If there's something to discuss, then I will talk to them or they'll have talked to them at the appointment.

I find the letters interesting for only one reason and that's the accuracy of the parts I do understand. You'd think someone would have picked up a 4yo was unlikely to be 192cm tall wouldn't you? Most of the letters I've had have had some glaring non-technical error like this. I just have to hope the technical bits are the bits they concentrate on.

What I don't understand I really don't need to know. "They picked up a C24 at test X3" (made up) is some sort of code which I can't pick up. I googled it, and asked dsis, who's a GP. Neither knew, although dsis could give a guess, which I suspect is correct.

But also you're picking the age you think it would be right. Parents might not agree. Dd1 likes to have some control, and know what's happening, she'd have been fine with a letter from about 8yo.
Dd2 is 12yo and is better not knowing as she panics and thinks the worst, sending her a letter that she might well take upstairs, read quietly to herself and I'd find her panicking she's going to die three weeks later. They present very similarly on the outside, but dd2 struggles to cope inside.

I think if you send one to the child you do have to be aware that they may well read it on their own, google it on their own, and not tell their parents anything about the letter, which could have serious implications.

My eldest is 9 so well below the age where he can consent to things himself (although I'm conscious that he will be old enough before I've had time to think about it properly!) All letters come addressed to me and DH although I share with him the bits that are appropriate for him to know, explained in a simpler way than in the letter. They go in his ringbinder of paperwork that he is allowed to see anytime with supervision. Same with my 7 year old. My 2 year old has done a little scribble in the box where the child can sign on consent forms since he could hold a pen and the anaesthetist will chat to him as well as me, although that's mostly so he doesn't seem so scary.

I think with older children if something requires commitment/co-operation from the child for it to be effective for example removeable braces or counselling then the child should have a say in it. I told the dentist I didn't want braces on my teeth when I was about 13 and he wouldn't do it against my will which was good I think although my parents weren't happy about it. Part of it was the dentist made a comment about taking out my baby tooth with no anaesthetic beforehand which made me not want anything to do with it.

Trust is so important between children, parents and medical professionals. I always make sure my children who are old enough are told why certain things need to be done and how they will benefit. I always ask the drs as well if test results are likely to change the treatment my child gets and the risks/benefits. My mum is always shocked by that as when she was my age you didn't question drs.