Sir, I am concerned by your headline (October 6), that medical correspondence may be outsourced to India. Hospital doctors habitually correspond with patients by letter, not e-mail, so communication would be likely to take much longer. A patient known to me is in the care of four different consultants. He describes appointments with them as like gold dust. He became aware that his scan was one day away from his next specialist appointment which required this information. He was able to telephone the consultant's secretary to ask to postpone the appointment to save both the consultant's time and his own. Had this information had to travel via India by letter, this time could not have been saved.

Patients with an illness causing them anxiety need to feel in contact with their consultants. Medical secretaries have always acted as underpaid, but invaluable, intermediaries. Our Government talks of patient-led care. The accountability of the NHS is a much-emphasised theme. Without medical secretaries one important personal pathway for queries and advice would be lost.

Dr M.I. Heatley, Oxford