Can I utilize a patient letter?

[Straw Hat]

Hey everyone, couple of questions. TLDR below.

So recently I had taken care of a patient (I'm a nurse) and her husband who was at the bedside the whole time sent my fiancé a very nice thank you email. I took care of his wife a total of three days and spent a lot of time in their room as she was in quite a lot of pain and they needed reassurance and guidance. I mentioned where my fiancé worked and he found her email and sent her a letter a couple of weeks later noting my compassion, patience, professionalism, and more. I've received thank you letters before but this one was particularly nice and touching. We don't often have patients reach out weeks later so it was truly just a wonderful thing to see and reaffirms why we do what we do.

My fiancé mentioned it to her dad who is a physician and has been involved in academic medicine and was at one point an interim dean / assistant dean (can't remember exactly) for a bit. He said I should utilize this letter in my application process. I plan on asking him more about this but I also wanted to ask here how this would be done. I've never been through the app process so I'm not sure where it'd be best if at all (obviously I'd leave off their names). I kind of hate to analyze this letter because I don't want to take away the personal meaning it has to me but if it can be helpful in this process and I can continue to help people in the way I did for them then maybe it isn't so bad to take advantage of this? And I'm not sure if this matters or should be indicated but the family is south american working class.

Also, as I'm compiling my LORs I'm trying to figure out what my best option for non science would be. My understanding is that since I'm nontrad and haven't taken a non science class in years I can get a work related LOR. So I think I have two options. The nurse manager (has a masters) who I believe would be supportive but probably not stellar as she hasn't actually seen me work much since I work mostly weekends. But perhaps she would ask my coworkers how I am and I know the majority of them would support me and have nothing but good things to say. Or a charge nurse who has worked beside me and been a nurse for 10+ years and already knows my intentions and is supportive of this. However she only has an associates in nursing and runs her own business on the side. Not sure which would be better but from what I've read on this site it seems adcoms care about the level of education of the letter writer. She would probably even opt for me to write a letter and then she would go over it and ok it.


TLDR: Received thank you email from patient husband noting my positive qualities, can and how should this be utilized in app process? Fiance's physician dad says yes.

Which LOR is better. Nurse manager with a masters, doesn't know me all that well, not even sure how supportive she'd be vs. charge nurse who has worked with me, really likes me, only has associates and runs a business on the side, knows my intentions and is supportive and would maybe even have me write the LOR and then she'd ok it or change what she wanted to change.

My 2 science LORs will hopefully come from an orgo professor and an anatomy and phys professor who says he will write a stellar one.

---

Members don't see this ad.

 

[Moko]

Would it be possible for one of your letter writers to reference the patient's letter and include in excerpts from it? This way you get the benefit from the patient's experience, in addition to additional thoughts from coworkers/managers. The main downside I can see to using just the patient's letter is that they've only known you for a total of three days, which could be seen as a negative (especially when there is a limit to the number of LORs you can send).

 

[Traumweber]

My 2 cents... "Positive Qualities" are subjective for evaluation because each of us has unique experiences. If you are applying for M.D, I strongly suggest looking at the AAMC guideline to letter writers. If you can get letters that address and evaluate (These are letters of evaluation) every facet mentioned on that document and choose appropriate people that can provide specific examples from interacting with you, It may help ( I don't know... never been an adcom). I have no idea how the D.O app process works though.

 

[Straw Hat]

With the charge nurse letter I'm sure this letter/parts can be incorporated/referenced, just not sure how that would be executed and done well. But now that you mention it I think that could be a great idea if done correctly.

The only known for 3 days thing isn't such a big deal to me. If I were on the other side like I'd personally be impressed with getting such a letter. But then again, that's how I feel and I'm not the one reviewing the apps or letters. Maybe I'm overestimating the significance of a letter like this. It's just that we hardly get thank you's let alone someone tracking down an email and sending a pretty long letter. I mean they were both thankful at the time but I was really surprised to get an email afterwards with so much depth to it (not just a "hey thanks again, you were great" kind of thing). So I would hope that anyone who's in healthcare would see some significance in that and view it in a positive light.

I wasn't sure if there are other aspects of the app process where this can be utilized, other than the LORs or PS. But incorporating it into a LOR sounds like a good possibility. I definitely plan on sending my writers a link to the guidelines. I haven't looked at the guideline in a while but I'm sure professionalism and compassion are on it. I'm not sure how subjective professionalism, compassion, patience, etc is in this type of setting though? But again, that's just my way of thinking and obviously I'm biased in this scenario.

 

[Moko]

I'm not sure how subjective professionalism, compassion, patience, etc is in this type of setting though?

These qualities are viewed very highly.

Best case scenario in my opinion would be for your letter writer to quote the patient's letter, perhaps even stating that this type of gesture does not happen every day, and then reaffirm that it's not surprising at all for you to receive such high praise as that is how you have operated on a daily basis for the past X years with your patients and colleagues.

The benefit of doing this is that your colleague/boss can also comment on your teamwork, reliability, broader skillsets, etc. something which may not be touched on by the patient you had. Just my thoughts.

 

[jl lin]

I have had families and patients send these to my employer/s unbeknown to me. Elements of such letters can be used if they create a LOR for me. I have also had this happen through courses w/ practicums of some sort, and family or pts had written to professors. I didn't become aware of them until I was approached by the managers or the professors. I have also had TY notes written to me and given directly or sent to my mailbox at work. I have kept them personal, b/c they were given personally. So it's really up to the person writing the TY and where they send it and if the professional writing the LOR includes such input.

Point: It seems more usable if it goes to the employer/professor and they use this when they write their LORs.

 

[Goro]

Don't do it, OP.

 

[thatwouldbeanarchy]

My two cents: Even though I'm sure the patient letter is really nice and probably does capture the exact qualities that will make you a great physician, it's still a personal letter. You should definitely steer clear of personal LORs for medical school. They're too subjective. As far as incorporating this letter into a letter from a supervisor... I'm not sure how that would work out either. You could certainly mention to your supervisor that you received a nice letter from a patient's family member and perhaps they might decide to mention in your LOR how much patients appreciate the care you provide. Going further than that, i.e., trying to have someone actually quote this letter, just seems a bit too forced, in my opinion.

Maybe an adcom or faculty member can speak more authoritatively on this but I don't think it's so important the education level of the person who writes your letter... But I do think it's preferable to have a supervisor write you a letter rather than a coworker. Again, a letter from a coworker runs the risk of sounding like a personal recommendation rather than a professional one. I'm not sure if the charge nurse you worked with would count as someone in a supervisory role?

But yes, in general, you can definitely use a letter from an employer for your non-science LOR. I'm also a nontrad and, for me, I think these letters were much more fruitful than my academic ones.

 

[Straw Hat]

The charge nurse is technically a supervisor in that she has some extra managerial responsibilities. Not as a charge nurse but she does the scheduling and pay for everyone on the unit. And when I go onto my clock in page she's listed as a supervisor 😛

As far as the personal letter. I guess I will just steer clear. I never even thought to use it until her dad mentioned it.

 

[jl lin]

There is nothing wrong w/ managers getting positive feedback in the form of notes and letters sent to them from appreciative families/pts seeking to write commendations.
What is on the weird side is using a personal letter or note directly in the application process.

References are best when they come from professional sources. Of course academic references must come from professors, etc, and research references should come from PI. So commendations are things that a manager, supervisor, and such could incorporate into their letters if they do it in the right way/professional manner. Thing is, how would you bring this up w/o sounding weird to the letter writer? You have to know how balanced and insightful your reference writer is.

Addendum:

I must clarify this. I would do the above only for say an SMP or PB, where they also want a reference from someone in a leadership where you have been employed. BUT for ms, I would follow the recommendations of the MSAR for LOR.

 

[gracie369]

OP, unless things have dramatically changed in the last 8 years I would think twice about having a LOR from any type of nurse sent in for a med school application. Clinical LORs should be from MD/DO only. Think about what the acronym actually means! Do you have any guidance at your undergrad?

 

[jl lin]

OP, unless things have dramatically changed in the last 8 years I would think twice about having a LOR from any type of nurse sent in for a med school application. Clinical LORs should be from MD/DO only. Think about what the acronym actually means! Do you have any guidance at your undergrad?

I'd agree w/ gracie. If you are not applying to a SMP or some post-bacc that would also like a reference from an employment, leadership person (in your case a NM, for example), yes. Stick w/ MDs/DOs and mostly I think they want to see strong LORs from science professors for formal application to ms.

I think one of the biggest mistake that some of us make is to not getting the MSAR soon enough.

@Straw Hat see my addendum in my post above. If you are straight shooting for ms school and not some SMP or something, follow the MSAR recommendations for LOR.

 

[Straw Hat]

I have the MSAR online and for the schools I've looked at it doesn't say anything except the min and max number of letters required. Specific information on what they want can be found on their website where it says for example physicians shadowed, supervisors, research mentors, etc. I'm kind of failing to see how obtaining a letter from a nursing supervisor who can attest to the qualities listed on the AAMC guidelines would be such a bad thing though..?

 

[jl lin]

I have the MSAR online and for the schools I've looked at it doesn't say anything except the min and max number of letters required. Specific information on what they want can be found on their website where it says for example physicians shadowed, supervisors, research mentors, etc. I'm kind of failing to see how obtaining a letter from a nursing supervisor who can attest to the qualities listed on the AAMC guidelines would be such a bad thing though..?

Yea. IDK. I don't make the unspoken rules. There are a number of nurses that are in ms or are past the process. I am sure if you posted, especially in non-trad to reach to them, they could give you their input on this.

I found this on SDN:

http://www.studentdoctor.net/2008/04/pre-med-preparation-getting-letters-of-recommendation/

 

[jl lin]

Excerpt from resource above:

[Who you should ask

The following people should write letters of recommendation for you:

• Physicians you spent time with.
• Managers of places you volunteered/worked at in clinical settings.
• Faculty who taught you.
• Faculty/mentors you did research with.

No personal friends, family, co-workers or others should write letters for you!

You should be able to get a personal copy of the letter from everyone with the exception of faculty, since they may be hesitant and most likely familiar with the closed file. If you have more letters than medical schools require, you can then choose the best ones to send to them. Most medical schools specify what types of letters and how many they want (usually one to four). Don’t send additional letters — they just clutter your file and your best ones may not get read at all. I recommended no more than three or four.
Christian Becker is the creator and operator of www.medschoolready.com and an SDN Contributor.]

According to this resource, managers where you have functioned clinically may be used.

It's would probably be good to reach out to some of the adcom advisors here as well.

 

[thatwouldbeanarchy]

If you're a nontrad who has been working, which it sounds like you are, it is totally acceptable to have work supervisors, though. Whether they are MDs/DOs or not! Think of all the nontrads who choose medicine after having a totally different career. @Goro, what do you think? Is it acceptable to have a LOR from a nursing supervisor?

 

[thatwouldbeanarchy]

You should be able to get a personal copy of the letter from everyone

Also, no, I would not ask for personal copies of your letters. As much as it's nice to know what your letter writer is saying about you, you want them to feel comfortable speaking candidly. AMCAS will ask you if you waive the right to access your letters. You're not obligated to waive this right but I think it's generally accepted that if you don't, your letter may carry less weight. This is why it's so important to choose your letter writers thoughtfully. Ask people that you have good working relationships with (i.e., don't ask the boss you recently mouthed off to or the professor whose class you slept through all semester--not saying you did any of this but you know what I mean) and trust that they will give you a fair and balanced recommendation.

 

[Goro]

A supervisor's LOR would be OK. The thing to keep in mind is what schools specifically ask for in LOR writers (ie, 2 science and one non-science Faculty, plus one other)

If you're a nontrad who has been working, which it sounds like you are, it is totally acceptable to have work supervisors, though. Whether they are MDs/DOs or not! Think of all the nontrads who choose medicine after having a totally different career. @Goro, what do you think? Is it acceptable to have a LOR from a nursing supervisor?

 

[jl lin]

Also, no, I would not ask for personal copies of your letters. As much as it's nice to know what your letter writer is saying about you, you want them to feel comfortable speaking candidly. AMCAS will ask you if you waive the right to access your letters. You're not obligated to waive this right but I think it's generally accepted that if you don't, your letter may carry less weight. This is why it's so important to choose your letter writers thoughtfully. Ask people that you have good working relationships with (i.e., don't ask the boss you recently mouthed off to or the professor whose class you slept through all semester--not saying you did any of this but you know what I mean) and trust that they will give you a fair and balanced recommendation.

You took that sentence out of context, and the sentence wasn't even mine. It was taken from an SDN contributor. Oy vey.

Here it is, again, in context:

You should be able to get a personal copy of the letter from everyone with the exception of faculty, since they may be hesitant and most likely familiar with the closed file. If you have more letters than medical schools require, you can then choose the best ones to send to them. Most medical schools specify what types of letters and how many they want (usually one to four). Don’t send additional letters — they just clutter your file and your best ones may not get read at all. I recommended no more than three or four.
Christian Becker is the creator and operator of www.medschoolready.com and an SDN Contributor.]

Here is previous part of the quote that precedes the above:

Excerpt from resource above:

Who you should ask

The following people should write letters of recommendation for you:

• Physicians you spent time with.
• Managers of places you volunteered/worked at in clinical settings.
• Faculty who taught you.
• Faculty/mentors you did research with.

No personal friends, family, co-workers or others should write letters for you!
People need to be careful about how they read, copy, and paste.

 

[thatwouldbeanarchy]

You took that sentence out of context, and the sentence wasn't even mine. It was taken from an SDN contributor. Oy vey.

Here it is, again, in context:



Here is previous part of the quote that precedes the above:

Excerpt from resource above:

I understand that someone else said that. I'm simply saying that I don't agree. In my opinion, the context only makes it worse. It seems like the author is saying that you might be able to get away with getting a non-faculty LOR writer to give you a copy of your letter because they don't understand the process. I think it's poor form regardless of who your letter writer is.

 

[Straw Hat]

A supervisor's LOR would be OK. The thing to keep in mind is what schools specifically ask for in LOR writers (ie, 2 science and one non-science Faculty, plus one other)

Yes, a lot of the schools pages that I've looked at ask for 2 science, 1 non, but if you're non trad and can't get a nonscience letter it can be substituted with a work LOR.

 

[thatwouldbeanarchy]

A lot of the schools pages that I've looked at ask for 2 science, 1 non, but if you're non trad and can't get a nonscience letter it can be substituted with a work LOR.

I submitted 2 science and 2 non-science, both of which were from work supervisors along with a committee letter from my postbac school (all submitted as a packet). This worked for pretty much every school I wanted to apply to. I think you'll be fine!

 

[jl lin]

I understand that someone else said that. I'm simply saying that I don't agree. In my opinion, the context only makes it worse. It seems like the author is saying that you might be able to get away with getting a non-faculty LOR writer to give you a copy of your letter because they don't understand the process. I think it's poor form regardless of who your letter writer is.

She's not saying "get away with anything."
No. You misunderstand. What the author is saying is that you may be able to get personal COPIES of the letters those other sources sent, but this WILL NOT PROBABLY happen w/ professors, ."..since they may be hesitant and most likely familiar with the closed file."

"Once more it reads as follows: "You should be able to get a personal copy of the letter from everyone with the exception of faculty, since they may be hesitant and most likely familiar with the closed file."

Getting a copy of the LOR from the other sources is not necessarily a big deal. People should stand by what they have said. End of the day you should only request letters of reference from people that will give you positive and strong references; even neutral letters can kill you. So you have to ask LOR-writers with this in mind.

Don't remember if I wrote this already, b/c my LT is very sensitive to the touch and moves off screen, sometimes causing me to start again.

I have read that you have used committee letters, so anyway, you know committee letters will be completely unseen by you and are a different story in that respect. 🙂

Faculty will be reticent b/c their evaluation and reference should be more analytical based on your work, attitude, and approach as a student.

 

[jl lin]

The charge nurse is technically a supervisor in that she has some extra managerial responsibilities. Not as a charge nurse but she does the scheduling and pay for everyone on the unit. And when I go onto my clock in page she's listed as a supervisor 😛

As far as the personal letter. I guess I will just steer clear. I never even thought to use it until her dad mentioned it.

So you are planning to apply next year?

Interestingly enough, I agree that charge RNs often see more of the nurse's real work, interactions, etc. What I have seen in interviews, at least for nursing positions, is that there is a preference for the actual nurse manager's reference--the person to whom you directly report. Don't know if there is a difference for ms, except that there generally tends to be a preference for direct reports. My thing is, if the charge nurse's position is truly a clearly, more balanced view, why shouldn't that be valid? In the work world, however, the "title" is the thing. I don't necessarily agree with it, but I don't run the world yet. LOL 😛

Wish you the best.

As a charge nurse and a nurse manager, I have written references for people. If there is someone for whom I don't feel like I could give a strong reference for more objective reasons (competency, clinical performance, weak knowledge-base, etc), that I won't. It can be challenging being diplomatic about this kind of thing. I am sensitive and don't like to say no out of compassion, but I have learned to be strong and understand the value of saying. "No."

It doesn't matter to me either, however, whether our personalities click the best or not. If I find they demonstrated, competence, care w/ patients and families and others, and have a strong and growing knowledge-base, then I will put personality differences/issues aside and look at the work and big picture.

I had a great NM, who was good with this sort of thing--a mentor to me. She always carried herself and her position as eschewing any hint of favoritism or cliquishness to an inner circle. I am sure she had some "go to" people, but she was very careful about that sort of thing, and was a true leader. She garnered much respect b/c of this. So, that's how I like to approach things like this.

We don't have to click and can even rub each other the wrong way at times. That is to be expected in life, people are so very different. But as a team on focusing on the patience and the work, that's where it matters. So, I don't blow off a reference b/c
"I just don't like" this person or that person. That's rubbish. If they are a true contributor, then they deserve to be recognized for it. Now, if they are a divider and ****-starter that undermines morale, that's a different story. This is the kind of reference you should seek out, especially if they have seen your work close up over a good period of time IMHO.

Point: Try to avoid renegade evaluators--letter-writers. 🙂