Patients in the UK have a right to receive copies of correspondence relating to their treatment, and some clinicians dictate letters in their presence too. Government and patient advocates favour these initiatives but neither has been evaluated to see if clinical outcome is influenced. An observational study of the practices of two Consultant Neurologists was undertaken, one of whom (RDS) routinely dictated letters in front of patients and sent them a copy while the other (AM) did neither. 72% of RDS's patients (n=263, over 3 months) and 62% of AM's patients (n=126, over 1.5 months) were questioned. 86 and 25% of RDS's and AM's patients respectively wished to be present during dictation (p<0.001). Within AM's patients, those who had had previous experience of the practice were more likely to wish to be present (p=0.023). 92 and 77% of RDS's and AM's patients respectively felt that having a copy of their letter would be “useful”/“very useful” (p<0.001). The perceived usefulness of receiving a copy letter and desire to be present during dictation were associated for the total group and RDS's patients. 81 and 93% of RDS's and AM's patients respectively thought that their understanding was “excellent” or “good”. Patients appear to like being present during dictation and receiving copy letters, but their understanding seems independent of these variables.