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3.  Reply to Letter to the Editor: Reply to Williams and Davidson 
PMCID: PMC2923815  PMID: 19358951
6.  Referral Letter with an Attached Structured Reply Form: Is it A Solution for Not Getting Replies 
Communication between primary care doctors and specialists/hospital doctors is vital for smooth functioning of a health care system. In many instances referral and reply letters are the sole means of communication between general practitioners and hospital doctors/specialists. Despite the obvious benefits to patient care, answers to referral letters are the exception worldwide. In Sri Lanka hand written conventional letters are used to refer patients and replies are scarce.
Materials and Methods:
This interventional study was designed to assess if attaching a structured reply form with the referral letter would increase the rate of replies/back-referrals. It was conducted at the Family Medicine Clinic of the Faculty of Medicine, University of Kelaniya. A structured referral letter (form) was designed based on guide lines and literature and it was used for referral of patients for a period of six months. Similarly a structured reply form was also designed and both the referral letter and the reply letter were printed on A4 papers side by side and these were used for the next six months for referrals. Both letters had headings and space underneath to write details pertaining to the patient. A register was maintained to document the number of referrals and replies received during both phases. Patents were asked to return the reply letters if specialists/hospital doctors obliged to reply.
Total of 90 patients were referred using the structured referral form during 1st phase. 80 letters (with reply form attached) were issued during the next six months. Patients were referred to eight different specialties. Not a single reply during the 1st phase and there were six 6 (7.5%) replies during the 2nd phase.
This was an attempt to improve communication between specialists/hospital doctors and primary care doctors. Even though there was some improvement it was not satisfactory. A multicenter island wide study should be conducted to assess the acceptability of the format to primary care doctors and specialists and its impact on reply rate.
PMCID: PMC4649877
General practice; referral letter; reply letter; structured letter
7.  Adequacy of authors’ replies to criticism raised in electronic letters to the editor: cohort study 
Objective To investigate whether substantive criticism in electronic letters to the editor, defined as a problem that could invalidate the research or reduce its reliability, is adequately addressed by the authors.
Design Cohort study.
Setting BMJ between October 2005 and September 2007.
Inclusion criteria Research papers generating substantive criticism in the rapid responses section on
Main outcome measures Severity of criticism (minor, moderate, or major) as judged by two editors and extent to which the criticism was addressed by authors (fully, partly, or not) as judged by two editors and the critics.
Results A substantive criticism was raised against 105 of 350 (30%, 95% confidence interval 25% to 35%) included research papers, and of these the authors had responded to 47 (45%, 35% to 54%). The severity of the criticism was the same in those papers as in the 58 without author replies (mean score 2.2 in both groups, P=0.72). For the 47 criticisms with replies, there was no relation between the severity of the criticism and the adequacy of the reply, neither as judged by the editors (P=0.88 and P=0.95, respectively) nor by the critics (P=0.83; response rate 85%). However, the critics were much more critical of the replies than the editors (average score 2.3 v 1.4, P<0.001).
Conclusions Authors are reluctant to respond to criticisms of their work, although they are not less likely to respond when criticisms are severe. Editors should ensure that authors take relevant criticism seriously and respond adequately to it.
PMCID: PMC2919680  PMID: 20699306
12.  Reply to letter from J. Finsterer and S. Zarrouk-Mahjoub 
Netherlands Heart Journal  2014;22(6):306.
PMCID: PMC4031360  PMID: 24399326
14.  Reply to Brodehl et al 
PMCID: PMC3658190  PMID: 23032113
17.  Reply to Richard Symes 
Eye  2013;27(6):779.
PMCID: PMC3682365  PMID: 23579413
18.  Reply to Grzybowski and Ascaso 
Eye  2013;27(6):777.
PMCID: PMC3682368  PMID: 23579409
19.  Reply to Matonti et al 
Eye  2013;27(6):778.
PMCID: PMC3682369  PMID: 23579410
24.  Reply from the authors 
BJA: British Journal of Anaesthesia  2014;112(6):1121-1123.
PMCID: PMC4020385  PMID: 24829427
25.  Medicine and Mind-Body Dualism: A Reply to Mehta's Critique 
Mens Sana Monographs  2014;12(1):104-126.
Neeta Mehta recently advanced the thesis that medical practice is facing a crisis today. In her paper “Mind-body dualism: a critique from a health perspective” she attributes the crisis to the philosophy of Descartes and set out to understand why this dualism is still alive despite its disavowal from philosophers, health practitioners and lay people. The aim of my reply to her critique is three-fold. First, I draw attention to a more fundamental problem and show that dualism is inescapable—scientifically and commonsensically. I then focus on the self-conscious emotions of shame, guilt and remorse, and argue that the self is not identical with a brain. The third section draws attention to the crisis in psychiatry and stipulates some of the main reasons why this is so. Contrary to Mehta's thesis, the health profession faces a crisis because of physicalism and biological reductionism.
PMCID: PMC4037890  PMID: 24891801
Biological reductionism; Brain; Dualism; Emotions; Guilt; Medicine; Neuroscience; Psychiatry; Physicalism; Remorse; Self; Shame

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