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At the heart of general practice since 1960

My week at the dangerous practice with no proper records

Hand-written prescriptions not detailed in the patient notes. And just what were one patient's 'special painkillers'? This single-handed practice was a locum's nightmare and a litigator's dream.

Hand-written prescriptions not detailed in the patient notes. And just what were one patient's 'special painkillers'? This single-handed practice was a locum's nightmare and a litigator's dream.

I had been looking forward to this week for a while. A whole week of working in the same practice, no crazy driving through endless traffic in my lunch hour, and it was not far from home. Even better, it was a single handed practice, meaning I would be afforded a little more freedom in how I could practice.

I was delighted also to be avoiding the question every locum dreads. While working other sessions, despite seeing twice as many patients as the partner I had been working with, there always followed the inevitable question "Do you mind doing the 3 house calls? Thanks"

Half past bloody 12 and expected to do three house calls in half an hour. Ideally, this would be a practice I would refuse to come back to, but because work is inconsistent and at times infrequent, I cannot be that choosy. I would smile graciously, do the visits, work through lunch again and hope not to be late for my afternoon session.

So I had a bit of a spring in my step as I walked through the doors of my new work place for the next week. Things started well, a nice morning surgery followed by one house call and then a bit of paperwork before lunch. The single receptionist/practice manager was doing her best to make me feel welcome and had supplied me with several cups of tea and a wide variety of biscuits.

Just as I was getting complacent, however, I was subjected to one of the most infuriating aspects of locum work, lazy documentation.

For starters all prescriptions were hand written. A habit, archaic and dangerous enough, made worse by complete absence of any documentation in the clinical notes. General note keeping was also lacking. On reviewing a patient with a changing rash – the only previous entry read "rash - emollient"

Trying to work out what a patients "special painkillers" were when they had no idea themselves, and then second guessing the absent doctor's management plan was almost impossible. My dream week was quickly turning into a nightmare.

It became obvious that I was covering for a doctor well on his way to retirement, safe and content in the knowledge that he knew his patients and they knew him. I was picturing an older guy, smoking a pipe, resplendent in tweed for whom documentation was a frivolous whim. Although I appreciated his fashion style I was beginning to hate his practice habits.

I muddled through and as far as I am aware nobody came to any harm as a result of my struggles. My experience at this practice was a bit of a wake up call though and I would like to think it has made me more vigilant with my own documentation practices.

As a locum, darting from place to place, with no follow up or continuity, I feel it imperative to document everything. I can't bring a patient back the next day for review, I can't guarantee to follow up on investigations I am ordering and I often feel a little exposed as a result.

I therefore document everything and ensure my plans are clear for the next doctor. This is to protect me but, more importantly, to protect the patient.

Too often, poor documentation is the easily avoidable cause of medical error. A simple and readily improved upon habit, good documentation should be the goal of every doctor; locum, salaried, or partner.

Those who fail to ensure adequate standards in this practice could risk their patient's health and leave them easy prey for litigators.

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