Hektoen International

A Journal of Medical Humanities

Learning medicine by writing letters

Matko Marušić


                          The Isle of Brach, Croatia

It was Tony, a learned doctor from the USA, who gave me the idea of having students write letters to their patients. He mentioned he had first heard about this some sixty years ago at Yale. At first he did not take seriously my immediate elation and determination to introduce it at the Medical School in Split.

I was serving as dean at the time. I had hoped to turn the institution into a modern and vibrant instrument of education that would bring glory to the whole city and area. But nobody had taken my plans seriously, ascribing it instead to overoptimistic planning. I nevertheless ran to the head of the Department of Family Medicine, Dr. Ivančica, one of the rare professors who had a boundless trust in me. Within a month we developed the idea. We made it part of the curriculum, requiring sixth year (final) students to each write a letter to one of their patients during their rotation in family medicine. They had to examine a patient and within a week send a letter summarizing the medical facts related to their case and giving advice for future health care.

The students questioned why they had to do this. They said they were already overburdened and had more important things to do. Eventually I followed Dr. Ivančica’s advice and recruited Dr. Nataša, a family practitioner from the neighboring island of Brač, to use this educational model as subject of her doctoral thesis. With charm, wit, and stamina, Dr. Nataša managed to continue the project for over one year, long enough for us to analyze the model and prove its educational value.

We loved the project but many were skeptical or opposed, arguing that students did not have sufficient independence, skill, and motivation to write comprehensible and useful letters. As typical doctors they would write sloppily and with poor style, murdering our beautiful mother tongue.

But what happened was unexpected. We could not believe our eyes! They wrote beautiful letters—long and complete, polite, professional letters. As we showed them to our friends and opponents (especially the latter) they had to agree that the idea was an excellent one. Moreover the patients also loved the letters, praising the students and referring to them as “doctors,” and claiming that for the first time in their life they truly understood what the doctor was telling them. They appreciated being able to read the letter several times, slowly, and in the comfort of their home. They also liked reading the letters to their spouses and have their comments.

When I suggested to the faculty that the hospital specialists should also write to their patients, the idea was met with stupefied silence; and the doctors’ union leader used the opportunity to argue, emphasizing the great work burden and infamously low salaries of his colleagues. And yet I feel that good ideas are worth pursuing and that deans should listen to wise and kind guys such as Tony.



  1. Mrduljaš Đujić N , Žitnik E, Pavelin L, et al. Writing letters to patients as an educational tool for medical students.
  2. BMC Medical Education 2013, 13:114 (http://www.biomedcentral.com/1472-6920/13/114)



MATKO MARUŠIĆ, MD, PhD, served for many years as a Professor of Physiology and Immunology in Zagreb University School of Medicine in Croatia and is currently Professor at the School of Medicine, University of Split, Split, Croatia.


Highlighted in Frontispiece Summer 2014 – Volume 6, Issue 3

Summer 2014  |  Sections  |  Education

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