Referral Letter Etiquette



I received a letter from a thoracic surgeon that was signed off, “With love and truth”. This caught me off guard.

The letter was on a normal-looking letterhead. It started with the conventional “Thank you for referring Mrs X for an opinion regarding…”, and went on to describe the patient’s presenting problem and comorbidities. It described the investigations undertaken, the treatments recommended and the plan for follow-up.

All stock-standard stuff, until the valediction: “With love and truth, Dr Y.”

This started me thinking about the evolution of the complimentary close. When I was at high school (which wasn’t that long ago), valediction etiquette was drilled into us. We were taught that correspondence other than personal letters should be signed off ‘Yours faithfully’ to those with whom one is not personally acquainted, and ‘Yours sincerely’ to whom one is. Clear, simple rules.

Then email came along and blurred the boundaries. ‘Regards’ and ‘Warm regards’ seemed to me to be a pleasant mix of the formal and the familiar. I used to think ‘Cheers’ was a little informal for use in business emails but it’s grown on me. However, a medical specialist’s letter signed off “With love and truth” is a different kettle of valedictorial fish.

To me, using the word “love” in a valediction has certain connotations. The trouble is that there are no clear rules of etiquette here. Most would agree that the word love does not belong in formal business correspondence, Dr Y being an obvious exception.

When it comes to personal emails and letters, though, it can be a case of “everyone’s playing the game but no one’s rules are the same”. I sign off “Love, Genevieve” frequently when communicating with friends and family by email. I mean ‘love’ as a term of endearment rather than ‘love’ in a romantic sense, and I write it almost subconsciously … except if I’m attracted to someone.

Now here is where it gets complicated. If I really like someone, but am not in love with him, I will think very carefully about how I sign my emails and usually will not use the word ‘love’ in case he gets the wrong impression. So, family members and platonic friends, male or female, will get “Love, Genevieve”. If I like someone romantically, he may or may not, depending on my depth of feeling.

Now how can anyone be expected to interpret that? I have male friends who sign some of their emails to me with ‘love’ and some who don’t. Does that mean anything? Almost certainly not, but if I applied my own process to them it might … which almost certainly would be wrong. An ex-boyfriend once told me that he signs his emails with ‘luv’ for close friends and family, and with ‘love’ when he’s ‘in love’ romantically.

His e-mail valedictions changed from ‘luv’ to ‘love’ at an apparently significant moment in our relationship. He was waiting for me to comment, giving him an opening to tell me that he loved me, but I didn’t even notice. If I had, I would have interpreted the change as his having learnt how to spell.

I can be fairly sure that my “With love and truth” thoracic surgeon harbours no such romantic feelings towards me. After all, I’ve never even met the man.

According to my patient, his quirkiness does not end with his letter endings, but overall, she is delighted with the care she’s received and the thoracic surgery has been a resounding success. That has to be worth a little love and truth.

First published in Australian Doctor on 19th April, 2012 On Referral Letter Etiquette–on-referral-letter-etiquette

Email gone astray

email pictureAn email gone astray can provide fascinating insights for an unintended recipient. Written correspondence has undoubtedly fallen into the wrong hands since homo sapiens first put pigment on bark, but never before has it been so easy to have a personal message go awry.

No longer is it a matter of surreptitiously steaming open sealed letters or snooping around in wastepaper baskets. Finding out another’s personal business is now just a click away. Even more conveniently, candid opinions can sometimes make an unscheduled landing in your inbox, making for intriguing reading — as I recently discovered.

I’m soon leaving the idyllic place I’ve called home for the past decade and moving to an equally idyllic part of regional Australia. Months ago, I’d sent out feelers regarding possible GP jobs and had emailed a particular practice principal a couple of times, expressing my interest. When it looked likely that I was going to pursue a different path, I sent a polite email explaining the situation and telling him I wouldn’t be seeking an interview for a job at his practice at present. An email bounced back saying that my not wanting to work for him may be “a relief” as I “sounded a bit intense”. It was sans salutation but, based on the rest of the content, was obviously intended for one of his work colleagues. It had no doubt been a simple error of his pressing ‘reply’ rather than ‘forward’.

I was chuffed: I’ve never been called “intense” before, at least, not to my knowledge. Perhaps there are several references to my intensity bouncing around cyberspace but this is the only one my inbox has ever captured.

I’ve never considered myself an intense person. To me, the term conjured up the image of a passionate yet very serious type, often committed to worthy causes.

Perhaps I had the definition wrong. I looked it up. The Oxford Dictionary gave me: “having or showing strong feelings or opinions; extremely earnest or serious”. Unfortunately, I couldn’t reconcile my almost pathologically Pollyanna-ish outlook, enthusiasm, irreverence and light-heartedness to this description — nor my somewhat ambivalent approach to politics, religion, sport, the environment and other “serious” issues.

At least the slip-up was minor. Several years ago, I unintentionally managed to proposition one of my young, shy GP registrars by way of a wayward text message. He had the same first name as my then-husband.

Scrolling through my phone contacts late one night, alone in a hotel room at an interstate medical conference, I pressed one button too many. Hence this innocent fellow received not only declarations of love but a risqué suggestion to go with it. Not the usual information imparted from medical educator to registrar!

It took me several days to realise my error, but despite my profuse apologies, the poor guy couldn’t look me in the eye for the rest of the term.

If I was “intense”, I would conclude on a ponderous note — with a moral message that would resonate with the intellectually elite. Alas, I’m a far less serious kind of girl and, as a result, the best I can up with is: Senders of emails and texts beware — you are but one click away from being bitten on the bum.

Published in Australian Doctor on 13th October, 2011: On Being Intense