About 10 years ago I went to a school reunion. My school closed down, taken over by property developments about 10 years after I left and amid the abandoned buildings, some ex-students from roughly the same ‘era’ as me, went to visit and collected piles of neglected paper records from the time, in an attempt to capture those recollections of our shared childhood.
At this reunion, they had brought these records for some of us ex-students to leaf through and to take those that might have related to any one of us. It was a living, breathing archive. Most of those attending didn’t find anything related to them. I, however, found an ageing blue folder stuffed with letters and a variety of official looking documents with my name on the front.
I took the file home. I knew some of what had been written about me but there was lots of things I hadn’t known about – the letters between the school and the social workers for example. I’d known of some social work involvement but hadn’t known or remembered the extent. It was painful to read some of the things – but what was particularly painful was reading the tone of the documents. I read how the school had really regarded me as flawed, damaged, problematic – when I thought of it as an escape and a haven. I read the letters between the school and my step-mother. I saw her letters and how she wrote about me with such venom and wondered why the school hadn’t considered any of this in the way they had interacted with me over the seven years I was there.
Then, after learning more about me than I’d really wanted to, I put the scrappy blue folder in on a shelf being unable to throw it away but equally unable to ever open it again. And there it has remained and still remains.
So why am I sharing this? Because recording matters. We know, as professionals about how we need to update care plans and risk assessments, we need to consult, discuss and share. We have targets for completing these well-regarded documents – and quite rightly. We know that reports need to be of a standard that is both accurate and respectful. But how much effort is put into reminding us the importance of those day to day notes we record on files and in documentation that tell the stories of the lives of others.
When I was in the community mental health team I used to work in, I remember the righteous indignation I used to bring to bear when I worked with people who were admitted to hospital and, on checking their care records, saw that the ward staff (who knew I would be checking because I would be adding to the records with my input) were filling the case notes with slightly passive aggressive ‘notes’ to me.
‘Mary’s social worker told us that she was waiting for our report but we have not been able to complete this because….’
I would usually send emails across to my manager about how clinical records should not be used as ways for clinicians to send ‘messages’ to each other because it was disrespectful to the patient (I still see this and it is one of my big bugbears!).
But as I look at the records we take about people’s lives, I realise how much they tell us about their attitudes – to their work but more particularly, to the people they are writing about. In my previous job, I was tasked to undertake an assessment for a Guardianship (this was pre-DoLS and the only guardianship I ever did as an ASW/AMHP) of a person who lived in a care home. I looked through her records and I was horrified by the tone of them. Those staff writing the records clearly regarded her with contempt because there was no respect in the tone. I remember having a go at the interim manager about this before I left and this actually set off a string of events (it’s a long story!) that led both to the patient moving (and initiating various safeguarding processes) and eventually to the home closing down amid a scathing inspection report (because yes, I did call the regulator). This was triggered by poor and disrespectful care records. Not the care plan documents, not the risk assessments but those notes we take on a daily basis.
I usually tell colleagues, when they stop to listen to me, that for all the beautifully coproduced care plans, those progress notes we add will say far more about interactions, quality of relationships and respect than any other documentation we use.
I have tried to be mindful of this. These records, these notes – yes, they are our work, but we are writing of and in the lives of others. We might be in a rush or overburdened with tasks but the mere act of writing in the clinical records of another human being, instils in us a phenomenal power over that person that has to be respected.
We are the authors of their stories and our tone does come through. So each time one opens a record to write, think about the person over your shoulder reading. Think about the child when they are grown and how they will understand what you wrote. Think about yourself when you are older and how you would like information recorded about you. Often I can tell far more about care provided and offered from those daily notes than any care plan or risk assessment. These are the records of lives and so they do not belong to us as clinicians or practitioners. It is a privilege to write the story of another human and even the briefest notes can always be written with respect.
Maybe no one will ever read what is written but ethically it is important to remember that having the ability to write a narrative with respect takes no longer than writing with flimsy language and language reflects our attitudes far more than we realise at times.