The problems associated with delayed typing- a doctor’s experience

Doctors do not work in isolation. They rely and are relied upon by patients, as well as a whole network of other health professionals. The web that ties all of us together relies on efficient and exact communication streams of which there are many examples. None however is more tried and tested than the written letter.

Long before the NHS, healthcare systems in the UK have relied on letters to detail patient consultations to others, including the patient themselves. The importance of a documented account of the meeting between patient and doctor becomes more evident the more complex healthcare systems become. It acts as a legal document, a note of reassurance, an exact layout of a treatment plan, and as such it becomes a documented trace of a patient’s journey through a complicated system.

The letter has not been replaced by newer technologies, such as phone, and email and in fact the NHS produces an estimated 12 billion lines of written text from consultations every year. This number continues to rise. The success of the letter may be partly a function of the disparate development between letter delivery systems and email or other telecommunication systems (the former having been around for hundreds of years) as well as it being more nebulously trusted.

My daily life is consists of the reading and writing of letters, and it is on these that I largely depend to tell me about a patient. I may see a patient in clinic and make decisions that will need to be acted upon urgently so I need to know that the letter that is dictated in clinic will be delivered. This is the problem with letters- there are too many stages between its creation and its delivery. I dictate, the tape is sent to the secretaries pile, and a week later I get to check the letter for errors. If there are none (if), it gets sent.

The problem is more clearly illustrated with a patient I met whilst doing an oncology job. The patient had recently been diagnosed with lung cancer, I had to dictate a letter to his GP so that he could have the adequate amount of oxygen in his house, as well as to the palliative care team who would look after his symptomatic needs at home. The letter was dictated. A week later I got a call from the GP to tell me that the patient had died, unexpectedly for the GP, at home. He had not had the palliative care support and apart from his family, had not had anyone to care for him during his final days. He had also not been given the oxygen he required at home. I went upstairs to the secretary’s office to find my badly spelt letter awaiting correction.

The advantage of digitising the process is that it is faster. The letter gets dictated and uploaded. Twenty minutes letter it is typed (often with minimal if any errors) and ready for signing. It can be emailed, or even sent for mailing at the click of a button. The additional advantage is that the letter can be retrieved easily. There is no need to dig through four volumes of notes as the letter can be found with a simple search. The whole communication process is sped up to the extent that information can be shared between practitioners before the patient has even returned home from a consultation.

I am a great advocate for the paper being in the hand, but before digitisation of the process, we were failing to deliver with the haste that healthcare needs to provide anything worthwhile. The faster the communication, the better for the patient.

 

By Dr S Zeki