Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Recognising The Need for Continuity of Care
- Paul A Fox (31 December 2004)
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More Rules & Regulation
- Andrew P Moltu, Julia Riley (1 January 2005)
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Patient held records
- Nick Berry (7 January 2005)
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Re: Patient held records..ask for them
- susanne mccabe (8 January 2005)
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Paul A Fox, GP/Hospice Doctor Wakefield/Pontefract
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I read Julia Rileys letter with interest. I have, in the past, spent a great deal of time promoting Palliative Medicine in Primary Care, with variable success. Much depends on the individual practitioners experience and interest in this area. This would probably account for the variable success rates in using "handover" forms to communicate with the Out of Hours Services. Making this a compulsory part of General Practice would seem to be the answer to bringing all practice to the same level. However, it is the initial decision which would then make the difference. "Would I be surprised if my patient died within the next twelve months?" The more cynical practitioners would probably answer "No" to virtually all of their patients. For the longer you practice, the less often you are surprised. But seriously, there are many patients in General Practice for whom the answer to this question would be "No". Many elderly patients who live in nursing/residential Homes, virtually all patients with chronic disease, including heart disease, COPD, neurological disease, the list could go on. The work load involved in "handing" these patients over to the Out of Hours service would be huge, more so for the Out of Hours Service than the individual practice. I applaud all work to improve continuity of care for those patients who most in need of it, and that includes all those with chronic disease. However, I feel that we must use more sophisticated systems which will meet to needs of patients in this group. This may well mean different systems for different diseases, possibly even different systems for different stages of one disease. Whatever the system used it must meet the needs of the individual patient. This will involve dialogue between Primary Care (including Out of Hours), Secondary Care and Tertiary Care practitioners to thrash out the detail. Asking the question "Would I be surprised if my patient died within twelve months?" is a useful starting point, but with the answer "No", comes a great deal of work for us all in the future. Competing interests: None declared |
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Andrew P Moltu, GP Limes Medical Centre LE19 2DU, Julia Riley
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Whilst having the utmost respect and support for the wishes of terminally ill patients as a GP one does get sick to the teeth of others telling one how to do ones job and that another form is mandatory for the GP to complete. It also suggests a certain lack of understanding of how out of hours primary care works these days. Homes are not like hospitals; terminally ill patients don't have signs hanging at the end of the bed with "Not for 222" written on them. A neighbour or carer coming across a collapsed cancer patient will either know that patients wishes or not. If they don't then are they going to search the house for the possibility of finding a form before deciding whether to dial 999? Out of hours GP service providers, at least round here, can't respond immediately due to the volume of workload. At busy times one can't get through on the phone particularly quickly let alone expect the GP to get there in a time frame that would allow resuscitation to be relevant. Out of hour’s call centres are centralised -the one in Leicestershire (with around a million population) is based in Birmingham where, no doubt, the call centre fields calls for even more patients than these. One would doubt they have the infrastructure to flag up the wishes to the patient to the call handler. Then one is left with the dilemma of whether or not to respond to the possibility that those wishes have changed or perhaps overridden by the next of kin. I'm all for patients making their wishes known but compulsory forms for GP won't make a real difference. Lets face it if form filling was the be all and end all hospitals & the DSS would be stunningly efficient organisations Competing interests: I'm a GP? |
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Nick Berry, GP Child Okeford Surgery, DT11 8EF
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I agree with Dr Riley's sentiment that sharing information like this is important in providing complicated care (but not just palliative care, and not just unscheduled care). Old Dr Finlay knew what was best for his patients, details that did not make it into his casebook (preferred place of care, current and past treatments, carer contacts, advance directives and so on) he probably just kept in his head. Most of us have moved on. Like many GPs I have found patient-held medical records to be useful vehicles for making this sort of information available to other "providers of care"- scheduled or not. They can be particularly empowering when the patient, their carers and health professionals all record and share the information they consider important. Competing interests: None declared |
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susanne mccabe, retired cf24 3pf
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The same old problem.....why should people registered with one GP be able to hold their own medical records without any problem...when in another practice they are not? Obviously people should be able to hold them without having to ask - yet even the right to have copies of their records is not being openly conveyed as a matter of routine good practice. Competing interests: None declared |
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