It’s that time of year again. All too often we receive cards from old friends and acquaintances that we don’t have contact with at any other time of year. We will send those messages to say ‘we must get in touch next year,’ knowing that we probably won’t.

 And then there are those round robin letters… Don’t worry. I’m not going to make fun about the way that they tell us how wonderfully the children are doing, and that the only disappointment that Sally and Tom faced all year was having to pop back from the Maldives early to get to the Nobel Prize ceremony.

'And then there are those round robin letters… Don’t worry. I’m not going to make fun about the way that they tell us how wonderfully the children are doing, and that the only disappointment that Sally and Tom faced all year was having to pop back from the Maldives early to get to the Nobel Prize ceremony'

I wonder how much longer the Christmas card will survive.

Why do so many of us still spend time and money sending bizarre and frequently unamusing pictures printed on card, when for absolutely no cost we can send as many emails as we want to everyone who has ever given us their email address?

Maybe perhaps that’s the answer. E-cards are just too easy, too instant, too lacking in feeling or effort to count as proper seasonal greetings, however much the environmental logic says that they have to be the future.

‘Many people get a real tingle of pleasure when an unexpected handwritten letter or card arrives’

There is clearly something that most of us value in receiving a tangible written message. It’s the same at other times of year too. Many people get a real tingle of pleasure when an unexpected handwritten letter or card arrives in the post. I lose count of how many emails I receive each day, but none of these ever has the impact of a handwritten letter.

I know it isn’t just me. Apart from rare exceptions, few of us would send an emailed note of condolence after bereavement.

Electronic communications have belatedly made their way into medical communications, even though snail mail and faxes have persisted far too long.

When we eventually all communicate our medical correspondence by email, what will become of one of the distinguishing features of private practice? You know how it is at the moment. A letter from a colleague who sees a patient privately will always be on much thicker paper than an identical letter about an NHS patient, and typically will thank you effusively for referring ‘this most pleasant patient’.

There is also a curious law of professional correspondence that leads both parties to address each other formally (Dear Dr Watkins…) until even the briefest of meetings that then changes all correspondence to a first name basis for decades to come, even if no further acquaintance is made. In the age of the easy informality of email, another bizarre medical tradition will bite the dust.

What about the Christmas cards you get from patients? Do you struggle like me in understanding why some particular patients include their GP in their seasonal messages while others would never dream of it? Another version of the inverse appreciation law seems to apply, in that ‘those for whom you do the most appreciate it the least, and vice versa’.

However, perhaps the greatest GP Christmas dilemma of all is when given a gift by a patient, how do you express gratitude and appreciation when the gift in question isn’t actually to your taste.

If only I had been rather more honest all those years ago and had not said ‘Thank you so much – how very kind’ then I might have received something other than the 25 bottles of Harveys Bristol Cream that marked my quarter century as a patient’s GP.

I’m not really complaining. It was good to be appreciated, even with sherry.