Letter:Accidental hypothermia: Central rewarming in the field.

SIR,-The study by Miss Anne Long and Dr. J. B. Atkins on communications between general practitioners and consultants (23 November, p. 456) raised many interesting points. Obviously t-here is plenty of room for improvernent on both sides. Some thoughts come to my mind as a result of my experiences in both fields of endeavour. The main source of information about patients in general practice records is often provided by letters from consultants or their deputies. A good letter or hospital discharge report is an invaluable record, and with the present pressure on hospital medical staff and shortage of clerical staff understandably these reports cannot always be prepared and dispatched quickly. This applies especially to medical cases, and similar factors explain the inadequacy of many referral letters. Letters from hospitals, however, provide a useful, legible and permanent record. Notice of a patient's discharge from hospital is a different matter. It should be dispatched promptly, with the full report to follow as soon as possible. Urgent advice on immediate treatment should be, and generally is, given by telephone or in a brief note with the discharge notice. The usefulness of domiciliary consultations is, in my opinion, lim,ited and consists mainly of providing reassurance to patients and their relatives or a means of opening up an avenue for the patient's admission to hospital. Such consultations are time consuming and the circumstances do not often pernit a deep discussion of the case. They can, of course, lead to better mutual understanding between the doctors concerned, provided they can spare the time.-I am, etc.,