I guess that fairly high on your New Year resolution list you’ll have, like me, ‘Avoid getting sued’. You will have read the recent story about the GP who was successfully litigated for allegedly giving inadequate advice about preconceptual folic acid.
You can almost hear the sound of GP towels being thrown in, and the crunch of reverse gear from potential new recruits.
Nabi, being thoughtful and analytic, took from this case lessons about the psyche of GPs and how it affects our sense of self-worth. I, being superficial and reactionary, took issue with something much more specific: the legal finger-wag that the ruling is a ‘reminder to practitioners to take clear and detailed notes of consultations’. Sod that.
Not least because it brought back dark memories. Years ago I experienced a mild but still hurtful rebuke for inadequate record-keeping, even though the associated complaint was dismissed. My diagnosis of ‘calf muscle strain’, rather than DVT, was 100% on the money, but I was advised that my notes weren’t. Why? Because I’d written ‘No clinical evidence of DVT’ rather than a detailed list of all the signs, or absence thereof, that justified this conclusion in the pre-Wells score era.
That rankled, and still does. Instead of being compelled to slavishly record the minutiae, why can’t we sensibly summarise actions and findings? This is simply pragmatism combined with professionalism. Condensing a lengthy process into shorthand saves valuable time and implies the usual practice of any reasonable medical professional – and Gawd knows we have enough scrutiny to ensure we’re that. Besides, some things barely need mentioning. For example, in this column, it’s correct to assume I feel immense sympathy for the individual with spina bifida involved in the case. I could have made a point of this, but for most individuals, and certainly caring professionals, it goes without saying.
So you’d think there could be a middle ground between cavalier brevity (‘chest pain, O/E NAD’) and hyper-defensive logorrhoea (‘chest pain, please scroll through pages of arse-covering, proforma-driven nonsense’). But apparently not. Just in case I draw the short straw in the litigation lottery, I have to type myself into RSI.
But I only have 10 minutes per appointment, and a lot can happen in that time; to document it to defence-body standards would at least double the length of the consultation. This would have two consequences: one, fewer appointments, longer waits to be seen and possible delays in diagnosis; two, medical notes becoming so dense that we can no longer see the signal for the noise – leading to error.
In other words, writing defensive notes could increase our risk of getting sued.
So it’s lose-lose. The only solution I can think of is to record every consultation – technology and secure storage permitting. Augmented, of course, by a running commentary to document any examination, with an explanation that we’re not being weird, the lawyers made us do this.
So that’s another resolution for you. Avoid seeming weird.
Dr Tony Copperfield is a GP in Essex.
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