Tuesday, 18 September 2012

Another slow death in the NHS

The art of letter writing is dying.

Just this week I received yet another pro-forma telling me how I could refer certain patients into secondary care. It emphatically stated that the pro-forma must be completed and that, 'letters are not acceptable'.

Now I know that letters can be badly written and contain inadequate information, but when well written they are irreplaceable. Not least they are generally more friendly! The proforma just does not paint a picture of the patient. Oh yes it'll tell me their height and weight, and their ethnicity and perhaps even the number of cigarettes smoked per day (although often because of the unnecessary information requested, it is difficult to find the crucial detail on such proforma, often times I look at a discharge summary from the labour ward, I can see how long the first stage was, and who the midwife was and whether any drugs were use, but can I see what (who?) the baby was?

Prose just gives more scope for description. My former Professor of Surgery at the Westminster Hospital,  Harrold Ellis, was fond of teaching us how to give a medical history at the bedside. An American exchange student was in my group and began presenting the case to the professor, he was like an automaton,

'the patient denies constipation, denies bloody stools, denies indigestion, denies abdominal pain....'

I think he would have go on were he not interrupted by the Professor,

'Can I suggest you start by saying,  this recently divorced 38 year old Bolivian ballet dancer.....'

Now I suspect non of us had much idea about such ballet dancers but we got the point. Mere list giving is somehow hollow and impersonal, a really well written, concise letter or a statement in prose, can say so much more.

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A message from the other side

No, not that side! But thank God got through surgery ok yesterday. And thanks to all for love support and prayer.