All patients attending the clinics will be given a sheet outlining the study before their consultations. If they are interested in the study, patients will be given a Patient Information Sheet and asked consent to take part. The length of each of the two dictated letters will be recorded. To avoid costs to the NHS, the direct to patient letters will be typed at the study investigators' cost. Two copies of each letter, a short explanatory letter and a questionnaire will be sent to the patient and the patient will be asked to circle points in each of the letters which are unclear and return them to the department. At the end of the study the general practitioners will be contacted and asked their views about the two letters.