Reading other doctors’ notes gives me a window onto their working worlds. I find their choice of words can be very revealing.
For example, the amount of writing a consultation generates can carbon-date a doctor fairly reliably, with an inverse relationship between the number of lines written and years since qualifying. There’s also a school of thought that values quoting the patient wherever possible (the pain was ‘like being hit with a golf club’). By contrast, some untrusting doctors pepper their notes with scepticism about ‘alleged’ symptoms, reporting ‘the patient states that…’.
I once did a project that involved looking into stacks of notes written by an endocrinologist, long-dead by the time of my research. It was a strangely intimate experience – like reading a diary, or somebody’s letters home.
I got to know favourite phrases, and favourite patients - as well as gleaning a sense of profound dislike of others. These were more candid times in medical note-taking: it sometimes didn’t take much nous to detect the author’s opinion of a patient. One lady, who had failed to lose weight despite lifestyle advice and the dietician’s attention, made the grave mistake of blaming her glands. Would any of us now write that we had ‘told this rather stupid woman that nobody her size came out of Belsen’?
In stark contrast, this week I became an admirer of another doctor I have never met. For rather mundane reasons I needed to read through a new patient’s paper notes. This was something I’d been putting off, but eventually I tipped the dusty pile out over my desk. Amidst the endless blood pressure readings and inane enquiries if (aged seventy-odd) he had recently taken up smoking, was one entry that made me sit up and take notice.
Here, buried amid the QOF-chasing and protocols, was another side of medicine – an entry that encapsulated the broad-shouldered acceptance of responsibility that is general practice at its best. It said simply:
“Bereavement visit. Wife died last week. I apologised for missing the MI that killed her.”
I don’t know about you, but that brings a lump to my throat. There have been clever diagnoses that I wish I’d been the one to make, and admirably rapid marches from vague presenting symptom to early intervention and cure, but that simple clarity and honesty is hard to beat. There are mistakes in every career. When my disasters come, I hope that I can meet them head on, and match that doctor’s integrity and courage.
Dr Nick Ramscar is a GP in Twickenham
