Notes
It is always drummed into us how important it is for us to keep clear, coherent and detailed medical notes. These are apparently real extracts from medical notes. They have been doing the rounds as an e-mail.
1 She has no rigours or shaking chills, but her husband states she was very hot in bed last night.
2 Patient has chest pain if she lies on her left side for over a year.
3 On the second day the knee was better, and on the third day it disappeared.
4 The patient is tearful and crying constantly. She also appears to be depressed.
5 The patient has been depressed since she began seeing me in 1993.
6 Discharge status: alive but without my permission.
7 Healthy-appearing decrepit 69-year-old male, mentally alert but forgetful.
8 The patient refused autopsy.
9 The patient has no previous history of suicides.
10 Patient has left white blood cells at another hospital.
11 Patient’s medical history has been remarkably insignificant with only a 40-pound weight gain in the past three days.
12 Patient had waffles for breakfast and anorexia for lunch.
13 She is numb from her toes down.
14 While in ER, she was examined, X-rated and sent home.
15 The skin was moist and dry.
16 Occasional, constant infrequent headaches.
17 Patient was alert and unresponsive.
18 Rectal examination revealed a normal-sized thyroid. (Thyroid gland is in the neck!)
19 She stated that she had been constipated for most of her life, until she got a divorce.
20 I saw your patient today, who is still under our car for physical therapy.
21 Both breasts are equal and reactive to light and accommodation.
22 Examination of genitalia reveals that he is circus-sized.
23 The lab test indicated abnormal lover function.
24 The patient was to have a bowel resection. However, he took a job as a stockbroker instead.
25 Skin: somewhat pale but present.
26 The pelvic examination will be done later on the floor.
27 Patient was seen in consultation by Dr Blank, who felt we should sit on the abdomen and I agree.
28 Large brown stool ambulating in the hall.
29 Patient has two teenage children, but no other abnormalities.
30 The patient experienced sudden onset of severe shortness of breath at home while having sex, which gradually deteriorated in the emergency room.
31 By the time he was admitted, his rapid heart had stopped, and he was feeling better.
32 Patient was released to out patient department without dressing.
33 She slipped on the ice and apparently her legs went in separate directions in early December.
34 The baby was delivered, the cord clamped and cut, and handed to the paediatrician, who breathed and cried immediately.
35 When she fainted, her eyes rolled around the room.
Lists
Please don’t bring a list of problems when you see your GP. I understand that you might not get to the surgery very often. Perhaps you have to sweat blood to get an appointment. Maybe you had to plead with your boss for the morning off and then beg our receptionist to squeeze you in. In fact, it is probably so difficult for you to get an appointment with your doctor, you’ve saved up all your niggling health queries that have been building up for the last few months and thought it would be better to get them all sorted out in one visit. Please don’t!
We have ten minutes per appointment. That isn’t very long, but we GPs pride ourselves in dealing with even quite complex problems during that short period of time. We have to get you in from the waiting room, say hello, listen to your concerns, take a history, examine you, discuss options, formulate a plan, write up your notes and complete any necessary prescriptions or referrals … all in just ten minutes! It’s amazing that we ever run to time. However, if you have saved up four problems to sort out, then that leaves just 2.5 minutes per problem. That isn’t very long and we’ll either spend 40 minutes with you and annoy the rest of the morning’s patients by running very late, or we’ll only half-heartedly deal with each problem and probably miss something important. This is clearly bad for your health and our indemnity insurance premiums.
If you do have a list of several problems, please warn us from the start and tell us what they all are. I’ve frequently had patients tell me that they are here to talk about their athlete’s foot and then after a leisurely ten minutes casually mention their chest pains, dizzy spells and depression on the way out of the door. If you have got several problems you want addressing, try booking a double appointment or decide what problem needs to be dealt with that day and book in another time for the others. Moan over. Ta.
Ten minutes
I see the ten-minute appointment as the patient’s time to use as they so wish. Most patients will fulfil the time in the conventional way with a discussion of a health problem that we then try to collectively resolve. However, any GP will tell you that not all consultations run like this. For example, one of my patients uses the time to tell me about the damp problem in her spare room and another about the affair that she is having with her boss that nobody else knows about. I have one patient who comes into my room, sits down and strokes a toy rabbit in complete silence. Initially, I desperately tried to engage her in conversation, but I have long since given up and now I get on with some paperwork, catch up with my e-mails and check the cricket score on-line. When her ten minutes are up, she gets up and leaves. She doesn’t even need prompting, a perfect patient!
Some people would consider these patients time-wasters but I don’t have any reason to judge a person’s motives for coming to see me. I’m not working in casualty. You don’t have to have an accident or emergency to see me. I’m a GP, which basically makes me the arse end of the NHS. If you turn up on time and leave after ten minutes, I’ll let you talk about anything. In fact, the three above-mentioned patients are among my favourites. My patient with the damp trouble has been updating me on her ongoing problem for months now. She enters my room agitated and upset and then erupts into a monologue on the woes of damp and the turmoil it is causing her. I do very little during the entire consultation other than pretend to look interested and reassure her that it is all going to be just fine. I do gently point out to her when her ten minutes are up or she would stay all afternoon. She is always eternally grateful that I have listened to her and insists that I have made her feel much better. She then happily goes to the desk to book herself in to see me at the same time next week. I also now know the difference between rising damp, penetrating damp, internal damp and condensation!
As for my patient who is having an affair with her boss, I always enjoy her visits. She is a solicitor’s secretary in her early twenties and has been shagging the much older married solicitor for some time. Each visit I get the latest instalment in graphic detail and I am left with an EastEnders-type cliffhanger to keep me in suspense until the following week. During the last visit she told me she was pregnant. The solicitor offered her £5,000 to have an abortion but she really loves him and wants his child. What was she going to do? Ten minutes come to an end – cue EastEnders closing music: dum … dum … dumdumdum … Okay, so yet again not exactly a great use of my expensive training and broad medical knowledge, but I like the