A patient's killer confession

27 November 2020 

I once came across the work of a murderer. His confession was clearly documented in his medical notes with a grisly account of the method of his dastardly deed.

The killing was pre-meditated, and I read with a chill how he had declared his intent to get rid of Pete, conceal the act from his wife, and how he urged his GP not to reveal the details of his crime.

Record keeping

David was diagnosed with extrinsic allergic alveolitis early in 2008. His breathing had deteriorated over the subsequent six months and despite impassioned pleas to his wife Sue, she had refused to get rid of Pete.

Sue was not renowned for her negotiation skills and had a reputation for stubbornness. She also was unaware of the harm her beloved pet budgie was doing to David’s respiratory health.

Left with no choice, David crept into the couple’s small, coal fire-heated living room late one night and did Pete in! His confession was recorded in his medical notes with the plea to all who were tasked with his ongoing care: "Please don’t tell Sue - or I’m dead!".

The GMC Duties of a Doctor instructs that we all have a duty to keep accurate and contemporaneous notes, and I am always struck at the end of my consultations by the number of ways this could be done.

In his remarkable novel Landmarks the author Robert MacFarlane at the beginning of Chapter Five recounts an experience where a peregrine catches a pigeon. He narrates it from several different angles: "What did I see that morning?" and it resonates with me on the many ways I could record a consultation after it has finished.

I do make a conscious effort to include as much codable information as possible, including numerical values, but try to include enough free text to ensure the next doctor treating my patient has a clear image of my thought process and management plan.

I also like to record informal information such as holidays and family events which helps prompt me to be able to talk to my patients about personal issues which matter to them, but don’t fit neatly into scientific data.

It is so important that we have good clinical data which is recoverable - it is vital to our role in research and services planning. As the old saying goes: "Garbage in equals garbage out!" or as our Research and Surveillance Centre (RSC) Chair Professor Simon de Lusignan describes: "Coding is caring".

We really want to help you do this well, so please let me know what resources would help. Would engagement with EMIS or Vision be helpful? Should we host a webinar on GPNI? Please get in touch with me - we would like to support you on this important issue.

The data collection part of the Winter Pressures work was discussed at RCGPNI Council last week and Council heard how some practices have experienced difficulties submitting this data by midday each Monday.

We will urge the HSCB to be flexible and show how this data is so important in disease mapping and will be an essential key into planning GP services into the future.

We feel it is very important that we engage with it constructively, but if you are having difficulty please get in touch with either your local LMC representative or our office.

Support for our community pharmacy colleagues

I remember my 21st birthday when my grandfather presented me with a beautiful fountain pen, just before my second MB exams. I was able to proudly tell him that it never failed a single medical exam and it inevitably helped improve my handwriting!

My dad used to send me postcards when I was boarding in Methody. I couldn’t read them and had to wait until the weekend to ask him what he had written! His wry reply still makes me smile: "You should have taken it to the local chemist. They can all read my handwriting!".

In the first few months of my GP registrar year I was humbled by how much I was supported by my pharmacy colleagues. I learnt to take their calls quickly because as a trainee GP they frequently kept me right.

Like our surgeries, community pharmacy colleagues have been under huge pressure throughout the pandemic, so please reach out to them and support them if you can.

My own surgery is lucky to have a porch which enables them to collect scripts and stay dry when it is raining!

Please have consideration for our colleagues and ensure there are good processes to let them collect scripts, facilitate communication with dedicated phone lines where possible and ensure patients are explicit about their preferred prescription destination.

Green issues

I mentioned in a previous blog about the opportunities to make our practices more environmentally friendly. The College has excellent resources to help with this and are worth looking at.

Dr Terry Kemple was the incumbent president of our college and is keen to link with any member of RCGPNI who would like to lead our work on this important issue.

If you would like to discuss this more with Terry, please let me know. There is no commitment if you are just wanting to know more, but it would be great if someone wanted to shape our NI position.

Retired GP forum

We are keen to grow and support our Later Career and Retired Members (LCARM) community. We are privileged to have Dr Mike Smyth representing the LCARM committee at a national level.

If you are interested in becoming part of an NI LCARM network or would like to attend a LCARM NI event, please get in touch with our Membership & Events Coordinator, Fiona Monaghan for more information.

You can also visit the RCGP LCARM page for an overview of national activity. 

Pancreatic cancer

Pancreatic cancer is often a difficult disease to diagnose and as November is Pancreatic Cancer Awareness month, I thought it was an important topic to highlight.

As a college we have been lucky to work closely with Mr Mark Taylor, Chair of the Royal College of Surgeons. Mark presented a webinar to GPNI on 1 October 2020 and the webinar and presentation slides are available to view.

At RCGP we are also running a free webinar on early diagnosis of pancreatic cancer. Pancreatic Cancer Action has great resources specifically designed for GPs.

These resources aim to raise your awareness of pancreatic cancer symptoms and help you to support your patients through their cancer journey.

A connected community

I’m really keen we view ourselves as a connected and supportive community, so if you have issues or areas you are passionate about please get in touch and we will see how we can help.

We are running monthly Zoom 'Click and Connect' drop-in sessions for you to join. These are informal sessions for you to engage with the College; you can stay for three minutes or 30 minutes. The next one is on Friday 4 December from 13:00 - 13:30.

It was great last week catching up with Dr Hannah Gillespie and hearing about her research plans. I am indebted to Professor Domnhall MacAuley who joined the meeting and was able to give Hannah some valuable advice on research.

This week we are due to meet with some more colleagues to discuss conversion therapy, LGBT issues and South West Federation to see how college can help.

Some of our GP colleagues are involved in the Irish Doctors Choir and on Sunday 29 November at 19:30 they are hosting a special concert, raising money for the amazing medical charity Medicines Sans Frontiers. Find out more and purchase tickets

I’m always keen to hear from you, so if you would like to catch up please get in touch with me. It would be great to chat.

Post written by

Dr Laurence Dorman, Chair of RCGP Northern Ireland

Dr Laurence Dorman took office in November 2019 after three years as Deputy Chair of Policy for RCGPNI. A GP principal in Mourne Family Surgery, Kilkeel, Co Down, since 2007, he is the fourth generation of GPs in his family. He was also, until recently, the Chair of Newry and District GP Federation. 

Laurence has particular interests in new ways of working in primary care, cancer care, and inspiring the next generation of GPs. He set up the successful Dear Colleague initiative to improve the interface between primary and secondary care and has been a strategic advocate for interface and communication since September 2017.

During his time as Chair, he wants to support College members to ensure that the future of GP services is protected, supported and sustainable.

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