Tuesday 23 November 2010


I have no doubt that patient notes have been the subject of many lectures, studies, and projects within hospitals individualy and the NHS as a whole. How to make them accessible and readable. I can only comment on my own experience.

When I was discharged, I was given my notes to take home, for the community midwife to use, until she discharged me, at which time they would go back to the hospital to be archived. I could not believe the size and volume of my notes, well over 100 A4 pages, from the day of my admission until the day of discharge. The handwriting was at times terrible. They were not in order. Oftentimes notes would say "written two days late as busy on shift". What use is that for the next person, especially when dealing with a complex patient situation?

I found my hospital admission, once Joseph was delivered, to be an incredibly difficult time. I felt that there was no communication between the ante natal ward, and special care. I felt my care was disjointed and problematic. I felt that if people had just read my notes, that life would have been so much easier, for them and for me. But who has time to read through loads and loads of handwritten notes, looking for the pertinent points. And what if the notes just aren't updated? Or inaccurate?

On the Tuesday, day 5 of Joseph's life, I had a really tough day. He was crticially ill, I had post natal blues, his teddy bear got stolen from my room, I was a complete mess. My husband's beloved football team were playing that night, a very important game, and I had said he was to go and watch it at the pub, but that was the day I needed him the most. I rang in tears and he came straight down before the game. The nurses and midwives gathered, to discuss what best to do. It was decided I needed a psychiatric evaluation. I didn't care, I just wanted someone to just take all this away, and make me normal. And give me back my pregnancy, or at least give me my baby.

I had my evening meal and went to special care, and spent time with my poorly baby, just sitting there, staring at him. From the chest up he looked fine, peaceful, cast your eyes downward, and he looked a mess, his tummy distended, the skin around his belly button turning black, he looked sick. And I was scared. My husband came in at once jubilant and despondent. His team had won, signalling Burnley's rise into the Premiership, but as he entered the room he could see his baby was sick, and his wife as a mess.

We went and had a cofee together at the beautiful cafe coffee machine outside special care and the delivery suite. We held hands. I cried a lot. At 10pm he kissed me good night and I took the long walk back to my room (my husband wasn't allowed in my room after 8pm at night who knows what we might have got up to!)

As I got back one of the kind, younger midwives came up to me and said "your having your psychiatric evaluation later, it will probably be around midnight, what would help until then?". I looked at her with huge puppy dog eyes and said simply "a bath". Well the ward mobilised, a nice big bath was run, the best towels obtained, and a nurse gently helped me in. I lay there patting my belly, and said goodbye to my pregnancy, and just howled a bit more. I really wished at that point I could just disappear down the plug hole.

I managed to get out, dried and dressed, and went back to my room. At midnight, sure enough, the knock came and a doctor came and spoke to me. She asked me all sort of questions, which I answered honestly but shortly. I just needed to get some sleep. She then said "right the problem is your methyldopa (for high blood pressure)" what we need to do is take you off that and put you on Labetelol, and you will start feeling better". My blood pressure started to rise, my face filled with anger.

"You haven't read my notes" (which was to become my catchphrase). She looked startled. "I have a history of reactive depression, methyldopa is contraindicated for depression, its true, but why wasn't I put on Labetelol?", she glanced at my notes, looked at me, and said "I'm sorry, I don't know." I felt relieved and annoyed, relieved she hadn't tried to wriggle out of it but annoyed that I seemed to be the only one who had a grips of my medical history. "I am a severe asthmatic, myself and Dr P the consultant felt that the risk of depression was better than my asthma being out of control, and Labetalol is contraindicated for asthmatics".

The doctor put down her folder, put her arm on my shoulder, and apologised. "You are in a time of great stress, you are very intelligent, you know what is going on, and you need us to be part of the solution, at the moment I feel I am part of the problem, and you need a good nights sleep."She left, I cried some more and I finally drifted off to sleep.

1 comment:

  1. I'm starting to think we must have been in the same hospital. I had very similar experience. I do think it's a darned cheek for people who don't know you to say they think you need psychiatric evaluation.