The pen is mightier than the scalpel

Toy medical kits contain all kinds of equipment: a stethoscope, an opthalmoscope, a bendy tendon hammer, a gigantic syringe. They never contain the most essential item of all: a pen. When you start work, no one tells you how much writing you’re going to be doing. Doctors on television never seem to make notes (although they may occasionally scrutinise a clipboard with a thoughtful expression). Doctors in film never seem to have “Bed 11 honeysuckle ward digoxin!” written in biro on the back of their hands. Medical school requires you to consume reams of paper, but rarely mentions that this is actually a fundamental part of your training. At the end of your first week of work, your wrist aches from the strain of handwriting. Eventually, you grow a Bic callous on your index finger.

Patients complain when they see staff sitting and scribbling in the notes. There is a perception that paperwork detracts from frontline endeavours. Surely we should be straddling someone’s chest and shouting “1,000 volts! Clear!” instead of covering 11 pages of A4 with our illegible handwriting. What, a patient’s daughter wanted to know, were we all writing all the time?

Doctors often feel the same way: and yet there’s no getting out of it. In the era of Facebook, Twitter and instant messaging, hospital life remains primitive. The fax is still venerated; email is regarded with suspicion. Almost everything is still done by writing with a pen on a piece of paper: requesting tests, maintaining lists of patients, prescribing drugs, keeping notes. Paper is perceived to be safer (there is a widespread belief that computers lose things); and more private (although anyone who has ever sat in a hospital canteen will probably have come across a mislaid patient list, full of every confidential detail you can imagine, headed with the hopeful words: “Private! Please bleep Dr Bob urgently if found!”

Every time you see a patient, whether on a ward round, during admission to hospital or as an emergency in the middle of the night, you need to document what you’ve found, what you’ve thought and what you’ve done. This is partly to protect yourself – if something goes wrong, the notes are the only way to show what you did: the hospital saying is “if you didn’t document it, it didn’t happen”. But it is also to enable everyone involved in looking after the patient to know what is going on.

With doctors no longer on 24-hour shifts, this is more important than ever; you are constantly handing over to people, and they need to be able to see exactly what’s happened so far. If you’re admitting a patient, there’s even more writing to do: a drug chart (some people are on two or three charts’ worth of medications), a deep-vein thrombosis risk assessment. Oxygen also needs prescribing, as does warfarin.

And then you may want your patient to have some tests. Some hospitals allow you to arrange these via a computer, but many still require you to fill out a paper form. To get an endoscopy or an MRI means answering a miniature questionnaire (full of infuriatingly detailed yet vital questions – when I started I was haunted by visions of my patient being torn from the scanner by the magnetic power of his overlooked knee replacement).

Filling in the form is not enough; you’ll also need to “just drop it off at the department”. As a general rule, your patient will be on the 11th floor and ultrasound will be in the basement. You can use the time spent waiting for the lift to update your list.

Sophie Harrison is a hospital doctor in South Yorkshire.

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