BLUF and the referral letter

Put your key question right up front in your referral letters.

Davina Stanley presented on the subject ‘Communicating with Clarity’ at our first Practice Coach Summit in 20##. Davina is the director of the Clarity First Program and author of the book ‘The So What Strategy‘.

Davina spoke about the importance of placing your key message early in your communication. This stratgey is known as ‘BLUF’ – bottom line up front. The acronym originally came from the military, where, she noted, ‘discipline around clarity of messaging can be a life or death practice.’

A traditional letter from clinician to clinician may run something like this

Thank you for referring this delightful 68 year old retired green keeper, Michael Busyman. who has recently moved to this area from Gosford to be nearer his 7 children and 16 grandchildren ……..

….. Michael has a history of tonsilectomy aged 7. He had a prolonged admission with a fractured fever aged 12 after falling off his penny farthing …..

— Babinski reflexes were upgoing and he had normal vibrations sense in both hands and feet ….

The questions around diagnosis and recommendations may well be buried in the final paragraph.

In a BLUF communication the key points will be highlighted first so that people reading the letter do not misunderstand what is required of them, or miss the key points altogether. The well crafted, narrative style communication can then follow.

I’ve started taking a BLUF approach in my referral letters by using a single sentence as the first paragraph highlighted in bold. Subsequent paragraphs will outline a history, examination findings and pertinent results.

  • Thanks for seeing Michael to determine whether his tremor is consistent with Parkinson’s Disease.
  • Thanks for seeing Mary to exclude coronary artery disease as a cause of her atypical chest pain
  • Thanks for assessing and managing Peter’s right inguinal hernia.

Perhaps by being ‘BLUF’ with our specialist colleagues we will get a BLUF reply.