The poor recordings of Gp's and Endo's

[Guest guest]

Hi,

Having just had a read through latest postings I noted something that Sheree had

out in her dealings with the GP etc - the word 'denied' came up a few times.

I have recently had to ask a GP to change something in a recent record where she

stated that 'patient denies mood swings' - like I had been asked if I had mood

swings and then promptly lied and said no. The conversation was off the back of

(this being my 3rd visit and with a different GP)my first visit I had been

tearful - due to having arrived from a very stressful workplace and feeling run

down - to by now having swollen lymph nodes and feeling physically unwell/query

Gland Fever - and saying that I was not depressed but I just felt very

physically unwell and exhausted - and this was translated into - patient denies

mood swings!!

A previous GP who's practice I left - only months later did I happen to see on

the screen when visiting my new surgery that he had put - 'having hot flushes

and is snappy with partner' - I have never had hot flushes - I am always on the

freeze side and I would never have made any comment about being snappy with

partner. This was around the time when he was pushing me down the menapause

route with all my symptoms which was proved other wise by the gynae endo I ended

up seeing.

When I asked PALS about removing this they said that my new GP can record by the

side 'patient does not agree with this' but it cannot be removed!

I think my point is that where posssible we must try to be careful what is

recorded on the IT systems when we visit our GP's - in my job when I do an

assessment of someone they have to sign to say that they agree with the contents

before it is finalised but apparently in health they do not have to do this.

Maybe we should be asking to see what the GP is recording at the end of the

consultation it shouldn't be an issues because they sit and do it before the

next patient goes in anyway so you are not taking anymore time up.

Information which is inaccurate and misleading can be very damning and follows

us around. It can and will influence what others think and how they may

approach dealings with you.

Just a loooooong thought.

Stacey