I agree with Geoffrey Lloyd's sentiments that much more evaluation will be required concerning the issue of copying letters to patients (Psychiatric Bulletin, February 2004, 28, ). My view is that this represents the most intrusive incursion yet by this Government into the central relation between doctor and patient.

My objections to this policy are several. First, on clinical grounds, I am concerned about the impact of this policy on the welfare of my patients who are children. As a child psychiatrist, one often makes judgements about the nature of attachment relationships and parenting abilities in parents of the children one sees. Frequently, it is in the interests of the child that other health professionals are aware of such difficulties, but not necessarily the parents as this may significantly affect the engagement process.

It seems to me that there are two ways of dealing with the problem of sending copies of letters to patients: one is to leave out information altogether, which I would argue is not in the best interests of the child, and the other is to render the letters so euphemistic as to be meaningless.

Whichever way one chooses to manage this problem, it is clear that we shall be discouraged from the use of medical language: and here we can see the other motivation of the Government in the current political climate, which is to deprofessionalise doctors; in other words, we shall be ‘dumbed down’.

The second of my objections is more practical and concerns the enormous administrative burden involved in responding to patients’ objections, queries, anxieties and sending out more mail: how is all this to be funded?

At a time when there are still great difficulties in delivering a decent health service to patients, it seems ludicrous that resources are being directed away from direct patient care to attempts at manipulating the public into believing that their health care is being improved by receiving copies of communication from their doctors. Is anyone really going to be fooled by this?