I read with interest the letter ‘looking at the patient’1 published in the April BJGP, especially as I have been reflecting on my own consultations recently.
I, too, have learned to touch type so that I can record notes while listening to and looking at the patient (except when I have to work in a room in the computer is angled in a different direction to the patient). I sometimes also ‘speak as I write’ so that patients are able to hear what I am recording, and can correct me if I erroneously type ‘right’ instead of ‘left’, for example. However, as a conscientious risk-averse doctor I find that I make longer notes than most of my GP colleagues, that has led to feedback that my notes are too long and take too much time for my colleagues to read. The length of my notes may be partly due to the fact that I do type quickly and can therefore record more data more quickly, but conversely I may be less discriminating in what I record.
Last year at my practice appraisal it was suggested that I try to type the data into the records at the end of the consultation rather than as it progressed, as this may help me to produce a more concise summary rather than the potentially rambling real-time recording. Looking back, this ‘summarising’ approach may have coincided with a slight but significant reduction in my consultation length, bringing it nearer to the allotted 10 minutes than my previous over-run. Unfortunately, I did not manage to continue this improvement, but looking back it might have been this change of approach to ‘summary recording’ that had helped me quicken my appointment time, albeit not maintained.
I do take pride in my thorough notes, both as a medico-legal defence and indeed for good ongoing patient care, or if I were to be hit by the proverbial bus. Interestingly, I heard it reported that a medico-legal advisor stated that half of the consultation time should be used for note-making, and of course if it isn't recorded ‘it didn't happen’. It is therefore hard for me to experiment with deliberately shortening my records that I take great pride in. However, it is something I am willing to try again, while still aiming to record a careful history with relevant positives and negatives, clear safety-netting advice, etc, in the context of high-quality, patient-centred, conscientious care. Actually while trying with this briefer approach again today I find that in some more complex presentations I feel compelled to record contemporaneously, perhaps haunted by a sleep-deprived junior house officer clerking, in that I hadn't recorded as I'd gone along and had to rely on the senior house officer kindly re-clerking the patient as I'd forgotten the details! The craft of perfecting the consultation, with its multi-tasking and varied demands, remains a challenging art that I continue to develop and review throughout my career.
- © British Journal of General Practice, 2010.