The GP should read my notes!

[Notedreader]

IABU to think most people don't understand what it means for a healthcare professional to 'read their notes'?

Inspired by a few threads I've seen recently.

Firstly YES it is annoying to have to explain things over and over to lots of different HCPs. However

1. The HCP will ask you what's brought you in today because they want to know the current issue as you see it. They may have had a referral letter from another HCP which says 'patient is having symptoms of anxiety' but you'll say that you're not anxious and you're having heart palpations etc.

1. 'The Notes' are generally not neatly ordered in a way you would imagine. It's lots of different systems/areas of the system. They'll be GP notes and referral letters and test results. They also frustratingly may not be able to see some of your notes if they don't have access to certain systems. This is annoying but also not the HCPs fault. They'll have likely read briefly into your medical history and current presenting problem.

1. They don't have time. GPs for example have 10mins per appointment. They had an appointment before and after you.

All that just to say yes it's is annoying and frustrating but patients who come in immediately with 'well haven't you read my notes?!' Isn't helpful to you or the HCP, you're on the same team. It's an issue of low staffing and all the other usual suspects.

Before anyone comments about unique situations and specific HCPs who have been genuinely bad at their job - that's not what I'm talking about. It's just that I don't think people understand what they're asking when they're asking for their notes to be read.

I agree with you about GP notes as they have so little time. However, I do think that specialists should take some time to get to know their patients on paper before seeing them. As a MH nurse, I always make sure that I read the last three entries on our system and the top 5 items on their GP notes before meeting them for the first time.

Yes I suppose its different with specialists, at least then there's more of a focus I suppose? Rather than looking at medical history as a whole.

I hear you

I'd definitely not expect my GP to have read my notes. I completely expect the opposite to be honest.

Even when they DO read your notes thoroughly, or you have a fantastic relationship, it’s not necessarily going to mean avoiding certain discussions.

I need to advocate for myself at many stages throughout pregnancy, as there is a blood work issue that comes up repeatedly as it is flagged in my chart as a potential risk. However, deeper into my notes there’s the well-established fact (test results and documentation) that because of my husband’s bloodwork, there is no risk to myself or our baby.

The thing is, they HAVE to keep that flag in my chart, because although when she stops and considers it my doctor always remembers that it’s all good… as a general practice they must keep the risk on file, because many women don’t have the same partner, or might be in circumstances where the baby isn’t actually their husband’s, and there’s no way to flag it “we promise this baby really is this lady’s husband’s so we can just delete this from her chart”.

So they raise it as a routine issue, I start to say “but…”, and then they look again at the notes and laugh and say “that’s right, we did it again, I’m sorry, yes there’s no concern here”. Over and over.

Doctors are human and with the multitude of notes in my chart on various health issues, I don’t begrudge them the ones that standard routine policy make them miss!

I don’t know if a GP has 10 minutes with a patient it would seem like better time spent actually talking to the patient vs. getting history already available in notes.

My mother complained a GP missed something from her notes from ten years ago. She knew it was relevant but seemed to treat it like a test of her GP and didn't tell him. Meant her cancer diagnosis was delayed. Stupidity.

I don't expect a gp to read my notes.

I do expect them to read the reason for the appointment (we have to do it online so we fill out a form with an area to give relevant details, which seemingly are never read).

I do expect consultants to have read my notes. The appointments are longer, they see fewer people in a day than a GP would, and if you see them often, they likely only need to check 6 months or so, if that. And yet I see consultants often who clearly have entirely forgotten me, have not refreshed memory at all, have not looked up anything relevant (Are unaware that procedures/tests orders have/have not been done etc). So we do spend a lot of the time recapping stuff they really ought to know (which they will promptly forget again later).

Completely agree. I had one consultant recently send me off for an MRI and call me back to discuss the results, yet clearly hadn't even glanced at my notes and had absolutely no idea who I was or why I was there (and this was private so less than 2 weeks between the two appointments).

She tried to blag it with 'so have you thought about what we discussed last time' and my response was 'well there wasn't much to think about, as we agreed we'd wait for the MRI results which we are meant to be discussing today' 🤦‍♀️

These are examples of people being bad at their jobs. I guess what I was getting at was that the whole medical history can't be reviewed, but, particularly with consultants and specialists, the current issue/on going tests should be looked over!

Rubbish that you've both had those experiences.

I accept they don't have time to gen up on your medical history before an appt but, when an electronic communication is sent from your oncologist asking them to prescribe this or that, I naively thought someone at the surgery might read it and react instead of blindly adding it to my record! The posted copy to me arrived 6 weeks later so I chased it for action but valuable time had been lost.

Of course I don't expect my GP to 'read my notes'. You'd need a working week to do that. And a bottle of malt.

I'd like them to have looked at the one pithy paragraph in my e-Consult form that led to them agreeing to ring me in the first place.

(We get 5-7 minutes now with my GP practice, not even 10. It's all a bit crazy tbh.)

I've never expected a GP to read my medical notes. The reason I'm in - sure. But reading about every flu jab, smear test, antibiotic prescription - heck no!

I work as a A&E clinician and the number of patients that expect me to know their entire medical history is unbelievable. We don’t have access to GP notes and we’re only able to look back at hospital admissions over the last 7/8 years or so since the notes system went electronic and even then it means clicking in and out of multiple documents to find anything useful.

Yeah I wouldn't expect A&E to access notes, but, I do expect them to look at the last few admissions, and then be prepared to listen to me.

I have gallstones that can't come out (well, they could, I'd probably die, no one will do it). Given my A&E record will show I have been admitted multiple times for this over 10 years it seems vaguely sensible I might know what works and what doesn't.

So insisting on giving me oral pain medications when I have come in specifically because I can't keep them down long enough to be effective, and now need IV medication... (and to check my gallbladder or bile duct hasn't exploded)... it isn't doing any of us any favours and results in a bay awash with vomit.

I realise people coming in and asking for IV meds is a red flag but I have zero other indicators for that and I am more than happy if IV paracetamol does the trick (as nice as the iv morphine is, the inevitable pukes 12 hours later I can do without).

One time I was treated as if I had spewed everywhere on purpose to irritate!

I don't know when we all accepted 10 minute appointments. If we want them to read the last few journal entries then they need more time.

Did any member of the public vote for or "accept" 10 minute appointments? Sadly, we dont seem to have much/any input and just have to put up with what we're given when it comes to the NHS... despite paying (tax) for it. I'd actually happily vote to pay more tax for a better NHS but again, there's no consultation with the general public!

We never 'accepted' 10 minute appointments.

It used to be 5 minutes!

10 minutes was a massive improvement.

it would take a few days for anyone to read all of ds notes!

i have mastered the concise history of his life to give to new professionals in his care (as well as having a written list of medication and other key information!)

yes in an ideal world they would be familiar with the history of every patient they come into contact with but that’s not realistic.

No I don't expect them to have read my whole history. But this is the reason why if I want to talk about my long term health condition I try to only see my GP. She knows me knows my history and doesn't asked all the questions that have been asked before. I get very frustrated if I see someone else as they will ask questions about haven't you tried this or that, that my GP already knows we have tried and I then feel we've wasted half the appointment going over old ground. It just seems to leave both me and the GP a little frustrated. Continuity of care for long term health conditions can be so important. Yes you could argue that fresh eyes may give a fresh perspective but I've never found that.

I'll see anyone for other things though.

If we make appointments longer we also make waiting lists longer.
10 mins is generally crap for both patient and doctor but people would be very unhappy about waiting longer for an appointment.

In general, I agree that reading notes and a full history is likely to take time that isn't available. However, perhaps a balance is needed... I feel it's dangerous to assume that a patient understands what is relevant/worth raising or not.

I have a history of issues (anaemia/tiredness, endometriosis/heavy periods) that are linked. If I didn't know that my anaemia was linked to blood loss (and some patients won't) and didn't flag it, nobody would think about doing anything other than throwing iron tablets at me. One GP recently prescribed iron tablets after a blood test to investigate tiredness confirmed low ferritin, told me to keep an eye on my diet and tea/coffee (tannin) intake, then indicated that I could leave before I asked if we could think about addressing the actual root cause, which was likely to be my periods/endometriosis. If I didn't know that myself, I wouldn't have thought to mention it, but ideally the GP (AKA the person with the training to make the connection) would have glanced at my notes, seen a diagnosis of endometriosis (which causes heavy periods), then raised/made the link for me, which I think is a reasonable expectation given that they are trained to have medical knowledge that most members of the public don't. If I hadn't been educated enough to know the likely cause, I would have thought they were completely separate issues (therefore not raised it) and walked away with a simple prescription for iron tablets and struggled on oblivious, leading to the issue reoccurring and likely requiring further unnecessary appointments.

I expect them to read my allergies to medications which are all flagged before prescribing me any medication, and it's helpful for them to read my medication list before questioning me on why I am taking certain things (high dose folate because I am on anticonvulsants has to be explained repeatedly, over and over again).

I find the ten minutes more than enough for the majority of things as long as I've written a good online appointment request information sheet and this has been passed to my notes (sometimes they just copy the first line), and if I go in with the format of issue, impact, ideal thing I need my GP to do... The vast majority of my appointment are around 3 minutes, but then there's notes and referrals to do as well.

I don't chit chat with my GP though - I do say I hope all is well and then we get on with the medical stuff, I don't need to know about her holidays, her tan, her new hair etc. I love my GP and we have a great relationship but she doesn't do chit chat during appointment (if she sees you are reception and she isn't busy then she just doesn't shut up...)

I agree. You spend more time describing the haircut you want to your hairdresser, or getting up to speed with a thread you’re following on MN. Yet we expect HCP to use the same amount of time for stuff that’s really important about our health. Madness.

I remember sitting in with an old school GP during my GP training who was still on 5 minutes. The quality of his consultations were appalling. No rapport established, patient's agenda ignored, throw antibiotics at it and show them the door. Definitely not the type of medicine I ever want to practise.

While many patients are aware of the time pressures HCPs face, a good few are not. We do need to communicate better with people and educate the general public about this, so that people don't think they are just being 'fobbed off' by the lazy HCP who just wants to get them out so they can make another cup of tea. Many of my patients are shocked when I explain to them that I can't address their second or third problem because their 10 minutes appointment was actually up 10 minutes ago and I have 17 other patients to see to that morning.

I'm passionate about the NHS and ensuring that we all have access to free healthcare. But this does mean there has to be some realism about what can be delivered by HCPs. In the private sector, GP appointments are typically 20-30 minutes but of course we can't offer that with the current public funding.