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There are four main types of error in medicine: failure to consider a possible diagnosis; failure to examine or investigate appropriately; failure to interpret signs correctly; and failure to record one’s actions.
According to our legal team, derived from many years of experience facing prosecution barristers’ probing questioning, if there is no written record of something being done then it will be assumed that whatever you claim you did, you didn’t.
At this point, the defence will usually concede and everyone will go home feeling depressed including the person wearing the suit whose job it was to write the necessary cheque.
The concept of proper documentation is the basis of the little humorous sign in the staff toilet brought back from an expedition to a souvenir shop, which shows a picture of a small child sitting on a toilet, in the style of Mabel Lucie Attwell, with the slogan, ‘The job isn’t finished until the paperwork is done'.
Unfortunately, and as correctly identified by the late Terry Pratchett in his fabulous Discworld series and attributed to his Arch-chancellor of Unseen University, things that are really important never get written down because when they happen people are too busy running about doing things and shouting.
While this unfortunately is often the case in our resuscitation room, where many aspects of the chaos induced by someone with critical instability crashing through our doors can go unrecorded, there is less excuse in the parts of the emergency department from which some barristers make their living.
In resus the assumption is that someone from the nursing team will document patient observations, drugs administered and fluids given, all in real time, while the medical team will write their bit up after they’ve taken off the blood-soaked rubber gloves and apron and found someone with a pen to steal while the other victim is being packaged for theatre, ITU, CT or the mortuary. Not so in minors where many of our legal problems arise.
The scenario will be something along the lines of our doctor overlooking the possibility of a fracture in an injured limb or deciding not to waste time on ‘unnecessary’ imaging, or failing to spot a fracture line on the X-ray.
Had the unfortunate doctor adequately recorded his findings and discussion with the patient and obtained agreement on the treatment plan with an escape clause along the lines of an appointment for review in five days if the arm isn’t better, the outcome and repercussions might have been different.
This is because most patients are reasonable and understand that life isn’t perfect and that we all make occasional mistakes.
In emergency medicine, forming the necessary positive relationship with a patient to secure their understanding and cooperation has to occur within a couple of minutes of introduction in a noisy environment where both parties are stressed, and one may be drunk and aggressive.
Little wonder injury lawyers drive expensive German sports cars.
Charles Lamb is a consultant in emergency medicine. He writes under a pseudonym