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RIP efficient patient notes, FFS


Continuity


We’ve become accustomed to epochal events. You know, Covid, remote consulting, mandatory advice and guidance. Turn the world upside down, yeah, whatever, we can cope.

Which must be why we’ve not even blinked an eyelid about something that should really have us running swivel-eyed for the hills. Specifically, the fact that patients with online access will soon to be able to read all new entries in their health records, including free text, letters and documents. Yes, I know, that’s so ridiculous it must be 1 April. Exactly – that’s when it starts. 

As the CCG techno-geeks explained at a recent TTL – having donned tin hats and pleaded with us not to shoot the messenger – we have a professional responsibility to ensure patients understand and are informed about their care. And that now extends to their being able to digest and comprehend everything as they plough forensically through their online medical records, quite possibly late at night and after a couple of glasses of wine, safe in the knowledge that a free e-consult translation service is only a mouse-click away.

And mark my words, there will be frenetic clicking. As the old cliché goes, you master a new language when you learn medicine, and not just some novel expletives to describe patients and the system. It’s the medicospeak of esoteric words, symbols and acronyms, conveying a mass of technical stuff. Now, because it’ll confuse and frighten the sodding punters, we have to unlearn it all – and instead re-learn plain English, which is going to take more than a few games of Wordle.

Don’t think this is an issue? Then you’ve never wasted prime consulting time providing subtitles for patients flummoxed by consultant outpatient letters that have been copied to them. Just explaining the word ‘lesion’ takes the best part of an afternoon. Nor have you encountered punters capable of mind-boggling misinterpretation, like the patient of mine on a slow-release medication who was furious because she thought the ‘Retard’ referred to her.

So say goodbye to ‘Polysymptomatic with SOB, TATT, HAs OE NAD, Dx supratentorial, TTFO’ and say hello to screeds of emollient plop. Either we double our consultation lengths to allow time for dumbing down and de-abbreviating the notes, or we carry on as we are and accept we’ll have to have to spend hours indulging patients with word-by-word translations like you would with toddlers trying to read Jean-Paul Sartre.

And that’s before we even consider the mind-numbing grief they’ll cause us after discovering minor non-specific aberrations in their blood tests, which will pose a far greater risk to our health than theirs. 

This is a bad, mad idea that could that could have been nipped in the bud simply by explaining, in a straightforward, non-technical and comprehensible way, that medical notes are complex, technical and incomprehensible because they are for qualified health professionals to communicate with each other, not for patients to share at their book club. But no one did this, because transparency is everything, right? Even when it means being able to see everything but understand nothing.

Which leaves us GPs as FNOF, Rx DHS with anaerobic post-op infection. Sorry, for any patients reading this, I mean broken, screwed and with something that stinks.

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs here

READERS' COMMENTS [4]

Nicholas Sheppard 21 March, 2022 9:26 pm

Everyone with “generalised anxiety disorder” will call up and suddenly say they’re not, on the weekends. Confronting a mirror is hard enough, let alone an app in black and white. Have you noticed how the NHS doesn’t create codes to show the public member is a threat or disturbance to staff, one could only find “argumentative behaviour”. Bit wooly and kind isn’t it.

Dylan Summers 22 March, 2022 1:23 pm

To be fair to your patient, the word “lesion” is pretty hard to grasp since its meaning is so vague.

I would define it as “thing which I don’t like the look of”.

Mike Baverstock 23 March, 2022 10:07 am

As usual Tony is spot on and superbly acerbic, funny and sarcastic – to name a few adjectives
The only thing I would say is that this might – hopefully – turn out to be like the Viagra scenario – this was when we all panicked – expecting hordes of ED patients. My stock answer to patients will be – ‘look it up on Google’. They all do anyway.
Dylan – I think Tony would say – with TIC (tongue in cheek) that it’s the patient he doesn’t like the look of. 🙂
In reality – we are going to have to add ‘possibly’ to a lot more diagnoses – to keep the wolfy lawyers at bay. Good luck all

Patrick Mcnally 23 March, 2022 10:46 pm

Sabotage code – 1364731000000104

“In addition, if a patient is identified at risk then adding the “1364731000000104 Enhanced review indicated before granting access to own health record” SNOMED code into a patient’s record will prevent record access from being provided should they subsequently create an online account. Access would have to be provided manually.”

I will be advising practices as data controllers that they may wish to apply this code to selected patients, certain patient groups e.g. LAC / CIN / CP plan kids,
OR, if they have insufficient faith in the processes NHSE and GP software systems suppliers have followed here – to batch code their ENTIRE patient list with this code.

Please do not misunderstand me – I am a patient centred (not patient led) GP, and patient empowerment is generally good for health outcomes. But this scheme doesn’t pass even the slightest inspection. And there is no resource.