Charting on short-term international medical missions: why bother?
August 31, 2016 |
When practicing on a volunteer medical brigade in a remote setting, why bother charting at all?
It’s a disingenuous question, and I will freely admit that it shouldn’t be taken at face value. But even if I don’t intend to tear down the entire establishment of medical record keeping, it is still worth considering the purpose of clinical charting – beyond a stalling tactic while working through a differential diagnosis.
In North America, the reasons are straightforward. First, it’s nearly impossible to remember the details of clinical encounters that may have occurred months ago, not to mention the results of lab and imaging tests. It may be that no one else can read one clinician’s scrawl, but we become remarkably adept at reading our own hieroglyphics and shorthand. Second, at the most painfully self-interested level, we need medical records for medicolegal protection in an increasingly litigious environment.
But none of this applies on volunteer medical missions and medical service trips. The original clinician will likely never see an individual patient again. Medicolegal issues are not nearly as pressing as they should be. The clinics are fast-paced and hectic, with volunteer clinicians often expected to see 25 to 30 patients, and charting only slows the process down. Then why?
Clearly, there is a third purpose: we chart to help the next clinician.
…but sometimes we’re not very good at it, as demonstrated by the above sample of a handwritten patient chart from Limon, Honduras. My own handwriting is no better. And in many clinics, the multiple charting formats used by the multiple short-term medical missions that visit the site further complicate matters. According to a 2002 study in the Journal of the Royal Society of Medicine, 15% of physician case histories are unreadable.
Handwritten records are efficient for capturing the patient narrative, useful medicolegally, and can be useful to the original clinician. But on a medical brigade, they fail in arguably their only purpose.
For the next clinician, handwritten notes become even more frustrating and time-intensive when looking for specific information in previous charts – a blood pressure, a blood glucose, a diagnosis, or a treatment plan. Which leads to my somewhat counterintuitive suggestion that electronic medical records may be more important in a remote volunteer medical mission setting.
There are around ten electronic solutions available to medical missions now, but pen and paper still rules (not to mention those groups who actually don’t bother with charting). With QuickChart EMR, we’ve created an app-based charting solution that requires neither infrastructure nor technical support, and makes charting as simple as using the smartphone in your pocket.
Download the free app to make your charting legible (or simply because you’ll forget the World Health Organization criteria for a diagnosis of chikungunya).
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