I defy any psychiatrist to say that they have not changed the content or nature of their letters with the thought that their patient would be reading what they have written. The change may be conscious or, more interestingly, unconscious. This may reduce the transfer of information to a general practitioner, for example.
While copying letters is most commendable in many ways and well appreciated, I believe that it does fundamentally alter the subtleties of medical correspondence. This does not seem to be addressed in the studies I have seen to date. It is a problem.
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