Written letters have long been a cornerstone of clinician-patient communication.1 The Academy of Medical Royal Colleges (AoMRC, UK) guides clinicians to write clinic letters directly to patients.2 However, this has not yet been widely adopted.

A principle of developmentally appropriate healthcare for young people (YP) is offering time alone in clinic to hear their perspective. Clinicians must consider the challenges of writing directly to YP. These include balancing the duties of confidential care with safeguarding, who to address clinic letter (and copies) to, what to share, the structure, style of writing and mode of delivery. This article addresses the complexities inherent in writing clinic letters directly to YP and incorporates views of YP and their parents (boxes 1 and 2).

‘I prefer it when the letter is sent to me, possibly my parents also. So long as there is a plan in the letter the GP knows what their role is. It is our body and health not the doctors.’

‘Two things I find vital in a letter are: accurate information and accurate relaying of opinion – both that of the patient and doctor.’

‘Hospital letters say a lot about the doctor who wrote it. As a young person/adult it is important to feel validated, heard and respected. The letters show it all. They indicate whether the doctor has listened, whether it says what was discussed and what they think of me.’

‘I have to admit that I do also like it when the doctor says that they were pleased to see me in clinic!’

‘I really appreciate it when the letter involves “We.” We discussed this or that and we have agreed this plan of action… This means it changes it to teamwork and as a patient I feel my voice and opinion matters.’

‘Including a …