Non-attendance at outpatients departments

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# More information was needed for non-UK readers {#article-title-2} EDITOR—The trial by Hamilton et al1 examining the effect of giving patients a copy of their referral letter on non-attendance at outpatient departments raises several interesting and controversial issues, but it is difficult to assess for an international audience who may not be familiar with the British healthcare system. This issue of being international has been raised by others,2 and surely if the BMJ aspires to be an international journal, the research setting needs to be clarified for international readers. For example, what is the usual referral procedure in the United Kingdom? In Hong Kong a referral letter is always given to the patient and is required for access to secondary care. Patients make their own appointments. Hamilton et al also fail to establish the justification for the research under discussion. What was the rationale for this randomised controlled trial? They hypothesise that a lack of communication between the patient and the referring doctor is the cause of non-attendance. If so, how will a copy of the referral letter be expected to improve this communication or guarantee attendance? An explanation of the topic antecedents and justification of the research question are required together with a discussion of the cost implications of this intervention Although Hamilton et al quote a national (England or United Kingdom) non-attendance rate of 12%, their own study had a much lower non-attendance rate. The situation in Hong …