Thursday, 12 July 2007

Salad days

"My salad days, when I was green in judgment."
We've been having a clear-out at home and I've come across a folder I prepared nearly twenty years ago. At that time I had only been practising for a few years, and from the evidence in the folder it looks as though I was always getting into trouble. Generally I've managed to avoid conflict with patients during my career, but this was not the case during my first few years. Of course I can't remember how I used to consult in those days but I suspect that I was more naïve and probably more intense and sure of myself. Nowadays, as Oscar Wilde remarked, I am not young enough to know everything.

I recall that there were two women in their fifties who made my life a misery in those early years. One suffered from urinary incontinence and went to see my partner to get her operation brought forward. He had an unbending character and refused. When she got no joy from him she came to see me and peed on my carpet to demonstrate how bad her incontinence was. After that I was only too happy to write to her consultant. The operation made no difference of course. She repeatedly requested visits for backache and other intractable symptoms following the procedure, and complained bitterly about my inability to help. Eventually I think she moved out of the practice area.

The other got her teeth into me in a big way. The folder I found still has a summary I made of her medical notes, and thirty years earlier a psychiatrist had said that she had an “unstable psychopathic personality with attention-seeking needs”. At our first consultation I noted a “long stream of symptoms”, we soon ran into trouble and after twelve months we were virtually at war. On one occasion she entered and said “I won't sit because I'm not welcome” and indeed she didn't but stood and harangued me for fifteen minutes before walking out. However on several occasions she said that the other GPs she had tried were worse than me. Eventually I removed her from my list and she came to see me one last time. I did not appreciate it at the time but now I realise she was trying to negotiate a reprieve. When this failed her final words were “I know why you want me off your list - it's because you've met your match. I'm not bloody stupid, love”. Looking back our relationship was ambivalent - with elements of love and hate. I think that she irritated me and I probably responded by winding her up. I'm not sure what she wanted from me, but I think that I could have been of more help to her after a few more years of clinical experience.

The folder also contains a vast sheaf of correspondence that she sent me during her last months with the practice and after she had been removed. Shortly after she was removed I began to receive “silent” telephone calls at home in the middle of the night. Until that time my number had been listed in the phone book. I changed the number and went ex-directory.

On a lighter note the folder contains some correspondence with Sue Grabbit and Runne, a local firm of solicitors that often do medical negligence work. A young lady had consulted me and I had diagnosed pregnancy. As a result she had given up her job, but when she got to the hospital “it transpired that she was not and never had been pregnant”. Dear me, a clear case of negligence! How can the young Brown avoid being taken to the cleaners by this valiant firm of solicitors fighting for the rights of their wronged client? I wrote back to the solicitors saying that my main reason for diagnosing pregnancy was the positive pregnancy test report that she had given me, and I looked forward to producing this in Court. I am still awaiting their reply nineteen years later.


The Shrink said...

I'm always a little uneasy about how much to keep and for how long.

Often when I'm 'phoned at night or go in to see someone (as Consultant Psychiatrists are wont to do at 2.00am because someone the police pick up is acting "a bit odd") I'll document some details. It makes sense to me, in case in the next few weeks folks want to know my impression or management plan and unless I wrote it down it's easily lost as other matters clammer for attention.

On the one hand it's nice to have written contemporaneous accounts of clinical contacts. On the other hand, such patient records contain personal information (and the on call stuff with elements of forensic psychiatry has very personal information).

Just in case a letter wings it's way from Bastard, Bugger and Brown Solicitors it's good to have notes to refute silliness. But how long do you keep such notes for?

As an aside, I guess you're showing it's helpful to keep them for educational reasons, showing a change in consultation style and allowing reflection 'pon that. I'm less sure that in future years for example my psychosexual history of an arsonist getting his kicks at 2.00am is going to be quite so illuminating though . . .

Dr Andrew Brown said...

I didn't intend to keep them this long, I just kept them safely in a folder in case of "silliness" and then forgot about the folder.

But it was interesting looking at the notes I had written. "The past is a foreign country, they do things differently there."

Whose records are they, anyway? They need to be kept confidential, but they as much as record of my past as the patient's. When a patient of mine died recently I made a photocopy of the first few sheets I wrote in her notes as a souvenir. She had consulted me during my first week in this practice, I saw her many times over the years and we had a very good relationship. I'm sure she wouldn't mind me keeping the memento. But I shall now shred the contents of that folder.