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