[Communication among physicians--impact, quality and requirements of discharge and referral letters]

Discharge and referral letters are essential for the communication among physicians. In contrast to Anglo-American research this issue has not received much attention in Germany, until now. For many years deficiencies in the quality of letters have been internationally reported in all medical specialist publications; these deficiencies relate in particular to the speed of delivery and the length of the discharge letters. Rapidly delivered, well-structured letters, one or two pages in length, with relevant information for outpatient care are preferred by physicians in private practice. The diagnosis, the results of examinations, lists of medications, and the suggestions made for treatment after discharge are essential items of information. The requirements mentioned with regard to discharge letters also apply to referral letters. From the point of view of clinicians, details about actual medications, suicidal tendency/aggression, current problems, the reason(s) for referral, drug intolerance and somatic disorders are felt to be indispensable. Details concerning guardianship, previous therapy, substance misuse, phone numbers of relatives, prior examinations, diagnoses, and previous examination findings are considered most important.