Medical Education Law Blog

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

I review many letters, e-mails, memoranda, and other types of correspondence prepared by my physician and nurse clients during my legal representation. These come to me often because of a dispute with a hospital, their peers, an insurance company, a lawsuit filed by a patient, a complaint being investigated by the licensing agency, an investigation of an incident, or another serious matter.

In many cases, way too many cases, such correspondence is unprofessional and defeats the purpose of the reason you are sending the correspondence. Sometimes the “letter” is so bad, that it will be disregarded by the reader to whom it was directed. I have seen this from doctors, nurses, dentists, psychologists, owners of health care businesses, and many, many other highly educated professionals who really should know better.

When I receive a “letter” that has no return address on it, no date on it is not addressed to a person or organization, has typographical errors and misspellings, does not have a paragraph, or is not signed, I cringe.

When such documents are dictated and transcribed by a professional medical transcriptionist, they are usually properly formatted and many of the errors I note below are avoided. However, when the health professional types (or word-processes) his or her own document or, worse yet, hand writes it, this is when I see the most errors.

To avoid these errors that make your correspondence and written communications look unprofessional, follow these tips.

Remember Why You Are Writing.

Remember, the basic purpose of your correspondence is to communicate ideas effectively. In many cases, it will be to invoke your legal rights in certain situations (such as an appeal or a hearing request). Sometimes, it will attempt to persuade your hospital, peers, or employer to take a certain action or refrain from a certain action. Remember that your correspondence is often the first impression that the other side will have of you. Do you want it to be an impression that you are sloppy, lazy, unprofessional, not knowledgeable, uneducated, or confused?

Whether you are communicating in a letter or via e-mail, these rules still hold true. In many (if not all) situations involving legal proceedings or legal issues, it is probably best to communicate via a letter sent by U.S. mail or some other reliable delivery service (e.g., Federal Express, Airborne Express, DHL, etc.). Even if you are transmitting your information via e-mail, it is my suggestion to prepare it in the form of a paper letter (if your e-mail is not set up to insert your letterhead and signature block automatically) and then scans it in and send it electronically.

I discourage legal communications via e-mail in serious matters because e-mails are often difficult to obtain, isolate, and authenticate when you need them for hearings. Additionally, they are rarely secure, often available to many others who shouldn’t see them, and easily susceptible to being accidentally sent to others who should not see them at all.

Horror Stories of Unprofessional Correspondence.

Why do I feel this article is necessary? Because of all the truly horrible correspondence I have seen written by allegedly highly educated professionals, mostly physicians and nurses. That’s why!

True “Horror Stories” About Unprofessional Correspondence

Here are just a few examples of true “horror stories” regarding unprofessional correspondence:

The physician never wrote a separate response to any charges or allegations made against him after receiving letters from the Medical Staff advising him he was under investigation. He would just hand write (scribble, actually) his remarks on the bottoms and in the margins of whatever document was sent to him and then send it back.

A nurse practitioner was required to respond to serious negligence charges, resulting in an adverse outcome for a patient. On unlined paper, she hand-wrote a response letter that was not addressed to anyone, not dated, not signed, and did not state who was sending it. There was no name or signature on it.

A physician was required to provide his analysis of a patient’s case for peer review purposes within the hospital. His typed letter of three full pages, single-spaced, contained one long paragraph. I used to work for a Medical Corps Admiral when I was a Navy JAG Corps officer. The Admiral, a very educated and proper professional, would just glance at such correspondence and state: “I can tell this doctor doesn’t have any idea what he is talking about.” Failing to follow good correspondence procedures will show others your thoughts lack organization and cohesion. A document that lacks organization reflects a mind that lacks organization.

A health professional was required to complete an application for clinical privileges. He wrote all of the answers by hand, not even staying within the lines on the form, writing over the questions printed on the form and around in the margins of the application. This is what he signed and turned in to the credentials committee at the hospital. Believe me, this did not look very professional.

A physician was requested to respond to a medical staff inquiry from the hospital. Her response came back typed (actually word-processed) in a type font that was 22 characters per inch (cpi), almost too small to read. Perhaps she was just trying to save a sheet of paper. But many of us would have had to pull out a magnifying glass or put on reading glasses in order to be able to read it. Once it is scanned or faxed and then photocopied or re-scanned and re-faxed several times, it will be completely illegible. If you are actually trying to communicate your ideas, make your correspondence easier to read, not harder to read. This is my cardinal rule.

A dentist was notified of a pending complaint investigation being opened against her dental license. She wrote her response to the charges back to the investigator, without using any business address or title, and began her response statement with “Dear Sharon,”. Do not treat others informally, especially in professional or formal situations. You will be deemed to be unprofessional when you do so. The investigator is not your friend, your sister, or your mommy. Do not address her by her first name. Do not end the salutation with a comma, like you would a love letter. End it with a colon like you would a professional business letter.

30 Tips for Good Professional Correspondence.

Here are some pointers on professional communications that should be followed in all of your professional written communications about business, professional or legal matters, even in e-mails. Please note, that the terms below in quotation marks have certain defined meanings. If you don’t know what these terms mean, look them up.

1. Always remember that the reason you are sending the correspondence is to attempt to effectively and accurately communicate your position and ideas. If you are trying to make your message indecipherable or difficult to understand, ignore these tips. If you are trying to come across as someone who doesn’t give a damn about how he or she is perceived, ignore these tips. If you want to come across as unprofessional, ignore these tips.

2. Make sure you include your complete and correct “return address” and contact information if you are not using your own letterhead. This includes your physical or mailing address, telephone number, telefax number and e-mail address, so that the other party knows exactly how to reach you. In cases where you already have this on your letterhead, be sure to use your letterhead (but only your own). Also, it appears more professional to create a letterhead with the information in it and to use your new letterhead instead of having a professional business letter with a typed “return address.” However, a typed “return address” is better than none.

3. Don’t use someone else’s letterhead. Don’t use your hospital, medical group or institutional letterhead for your own personal communications, unless you are the owner. Use your personal letterhead (see above), instead. If you are being accused of poor utilization review, unprofessional conduct, or personal use of hospital (or company) property, then using someone else’s letterhead just helps prove the charge against you.

4. Date your correspondence. Date your correspondence. Date your correspondence. Nothing shows a lack of professionalism and lack of attention to detail as sharply as undated correspondence. It will certainly be difficult to prove when your letter or document was sent if you do not have a date on it. A year or two later, it may be completely impossible to do so. In case I forgot to mention it, be sure to date your correspondence.

5. Use titles or honorifics. In the “business address” of your correspondence, always use the complete name of the person to whom you are writing (if known) together with that person’s honorific or professional title (e.g., Mr., Ms., Dr., Nurse, Prof., Dean, etc.) This shows both respect and professionalism.

6. Always use the complete mailing address, including the title, of the person to whom you are sending the letter. The business address of your correspondence includes not only the person’s name and honorifics but the title or position and division within the institution or organization to which you are sending it. In the case of large organizations, you should include the building and suite or room numbers and any internal routing codes, designations, “mail stops” or other organizational routing codes, that the agency or business you are writing requires to route its mail internally. Large organizations, especially government agencies and insurance companies, all have large mail rooms that sort and route all mail the organization receives from any source. Correct internal routing codes will help ensure that your correspondence gets to the correct person or official in a timely manner. Often today companies scan or have all e-mails saved by a clerk, as well

7. Always use a salutation. This is self-explanatory but see below.

8. In your “salutation,” always use the person’s last name with a title or honorific. It is customary to use the term “Dear” in a salutation in formal writing, so this is permitted. But you may leave it out. For example, “Dear Secretary Jones:” or “Secretary Jones:” or “Dear Dr. Johnson:” or “Dr. Johnson:”; all of these are correct. Never refer to the person by that person’s first name in any type of formal correspondence or correspondence that anyone else might read. Never say: “Dear Sue:” or “Sharon:”. Even if you know these people well enough to call them by their first names, don’t do it in this situation; it’s unprofessional and may be interpreted as “talking down” to the person.

9. Always end your “salutation” with a colon, not a comma. A comma is only used in informal communications to those you know well or socially, such as a letter to your mother or a note to your girlfriend. Unless this is your mother or your girlfriend to whom you are writing, use a colon. For example, “Dear Secretary Jones,” or “Dear Sue,” is incorrect. “Dear Secretary Jones:” or “Ms. Smith:” is correct.

10. Type (or word-process) your correspondence or have it typed (or word-processed) for you; this is one reason transcriptionists, secretaries and clerks have jobs. Do not send handwritten letters in formal or professional matters. Do not write on the other person’s correspondence or documents and send them back. Prepare and send a professional-looking letter or e-mail, even if you must pay someone to type it for you (and if you are sending an e-mail, I know you can type a little bit yourself, anyway). To do otherwise is to show laziness, disrespect and unprofessionalism.

11. Always use a type font in your correspondence (including e-mails) of at least 12 points (10 characters per inch). Do not use small, difficult-to-read type fonts, for example, the size of the type font that most e-mail software defaults to. Smaller type fonts than 12 points become difficult to read, especially if scanned/rescanned, faxed/refaxed, or copied/recopied. Change the default font in your e-mail software or computer word processing software, if necessary. You can do this, regardless of how difficult it may seem at first; I know you can do it because I can do it. Make your professional correspondence easier to read, not more difficult to read.

12. Never use unprofessional-looking type fonts for your communications. Stay away from script-type fonts, italics, or novelty-type fonts. These are notoriously more difficult to read and look unprofessional. You are not publishing a flyer for a high school bake sale. Times New Roman, CG Times, and similar type fonts are more professional looking and easier for a person to read. Use Courier or Letter Gothic type fonts if necessary.

13. Keep the correspondence to which you are responding unmarked. One reason to not write on or mark up the other person’s documents or correspondence is that you may need them as evidence in a court of law or a hearing someday. Nothing looks less professional than a document you are trying to use as evidence when a different person has made handwritten marks all over it. The impression is similar to one in which a child with a box of crayons has gotten to it. You don’t want this or need this. Show respect and self-control. Keep the other side’s documents pristine. They will look much better that way as your “Exhibit 1” in the court hearing.

14. Use a good concise, descriptive reference line or subject line (often called the “re:” line). Make it a very brief summary. State what the content of your letter is actually about. State if you are responding to a letter or document that you received from the “addressee” (the person to whom you are addressing your correspondence) of your letter.

15. Include the recipient’s routing information. If the intended receiver of your letter or correspondence (the “addressee”) included reference numbers, file numbers, account numbers, case name and numbers, a policy number, an investigation number, a routing number, or other similar information on its letter to you, repeat these back in the reference line of your correspondence. This will help make sure that your correspondence gets routed to the correct file and recipient more timely. This is especially crucial in large organizations and government agencies.

16. The contents of the body of your correspondence should be easy to read and easy to understand. To this end, be sure to use short sentences and short paragraphs. Each paragraph should convey one idea. Use headers and section titles, if necessary, to organize your correspondence, especially if it is lengthy. Remember, headings within your letter that help to organize it are like street signs in a busy city. They will really help any subsequent reader (and this may be a judge, a jury or a Board of Mediciney) to navigate his, her or its way through your letter.

17. Be sure to skip a line between each paragraph and, preferably, indent the first line of each paragraph. [Note: Some writers will tell you not to indent the first line of each paragraph in professional correspondence; however, I feel that this makes the correspondence more difficult to read, so I encourage indenting or tabbing in on the first line of each paragraph.] This makes it easier on the reader and more likely that your ideas will not get lost in a crowd of words.

18. Keep your paragraphs short and to the point. Nothing turns readers off as much as a single lengthy paragraph written from margin to margin taking up the whole page. I suppose some people may have never been taught what paragraphs are. However, I am willing to bet that most were. These rare used even in foreign countries.

19. In longer correspondence, use section headings (in bold or underlined) or headings for each issue, to better organize it. Think of these as road signs on a long road. They help the reader to know where he or she is at any given time, and where he or she is going.

20. When using headers, skip two lines before the header and one line after the header. This helps to set off the new section and header and show a definite division.

21. Keep your language objective and professional. Do not ever use profanity [Oops, I just went back and removed the word “damn” I used above.] Do not ever use any comments even remotely resembling racism, sexism, or antisemitism or prejudice. Do not be sarcastic.

22. Be direct and concise in your language. To the greatest extent possible, use the same terminology and wording that the other party uses, or has used, or the wording used in whatever statutes, regulations, policies, procedures, instructions, or governing documents with which you are dealing (but also, be sure you know what the words and terms mean).

23. If you intend to request a formal hearing say “I request a formal hearing.” If you want a full refund, state: “I request a full refund.” If you want to appeal the decision, state: “I want to appeal the decision.” Don’t be wishy-washy or vague. For example, don’t say, “I am looking for an attorney to file an appeal for me,” when what you mean to say is “I appeal the decision” or “I request an appeal.” Say precisely what you want. Don’t be vague or leave the reader guessing.

24. If there are any deadlines by which you must respond, be aware of these and make sure your response is received by that date. Remember “received” means “actually received” by the correct person (or office) at the correct address. It does not mean “mailed by” or “postmarked by.” If you have correspondence or a document to which a response must be received by a ceratin date, you need to make sure it is actually in the receiving person’s hands by that date, even if you must hand carry it to that person. I will usually send important documents by two different methods, in case the mail man dies, the courier service’s plan crashes or the e-mail server goes down.

25. In closing your correspondence conclude by stating what action is next, whether this is action you intend to take, or action you are requesting the other party to take. For example: “I expect to hear from you within ten days as to whether you grant my request or not.” “Please contact me with hearing dates within the next fourteen days.” “I will forward you a refund within five days.” “I will send you my records within five days.”

26. Always advise the other party of exactly how they should contact you; provide multiple means of contacting you. If you are very busy or have an assistant who is authorized to act for you, provide that person’s name and contact information to use as an alternate, as well. Then be available to receive the return communication(s). Don’t give telephone numbers you never answer. Don’t provide an incorrect address (e-mail or physical).

27. In dealing with dates and deadlines, remember that ten days is ten days; fourteen days is fourteen days, twenty-one days is twenty-one days. Made up rules such as “weekends and holidays don’t count” are just that, made up (outside of formal court proceedings). If the other party has given you “fourteen days to respond,” this means fourteen days from the date on the letter, unless specifically stated otherwise. Fourteen days means fourteen days, unless it is specifically stated otherwise (e.g., “you have fourteen business days to reply”).

28. Include a professional closing above your signature. This should be “Sincerely,” “Sincerely yours,” “Respectfully,” “Respectfully submitted,” or some other professional closing. Do not conclude with “Love,” or “Very truly yours,” despite the tradition.

29. In your signature block, include your full typed name, with credentials and title or position listed. For example, your full name, followed by your degree and other credentials (e.g., “John J. Smith, M.D., F.A.A.C.P.”) should be on the line immediately below where you sign. Next should be listed your position within your organization (if applicable) (e.g., “Chair, Pediatrics Department”).

30. If you have enclosures, list them at the end of the correspondence, giving a brief or shortened description and numbering them (this is slightly different from military correspondence). List and number them in the order you discuss them in your correspondence. Be sure they are properly organized, labeled, and divided, especially if any are lengthy.

Following these simple rules, most people learn in middle school will help to keep your correspondence professional looking and in conformity with what most professionals see on a daily basis. If your correspondence is professional-looking, people will be more likely to think you are a professional and to treat you professionally.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, Florida 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
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