Showing posts with label medical records. Show all posts
Showing posts with label medical records. Show all posts

Friday, 30 May 2014

Guest blog: Dads, Dogs, Diabetes & Data by Louise Brady

I was delighted and touched to be contacted by Louise Brady who asked if I would host a blog post she had written. When I read it, it made me excited about the future of diabetes care and the possibilties of communties coming together and really making a difference. I'm looking forward to seeing how the journey unfolds!

If you aren't already following Louise on Twitter I recommend that you do. You can find her on Twitter here: @louisebrady17


Dads, Dogs, Diabetes & Data by Louise Brady


My mother’s beloved dog has recently been diagnosed with Cushing’s syndrome. Exasperated, she declares ‘endocrine disorders are rife in this family’... and now extends to our family pets!’

She is right of course... In my family we have a mix of diabetes, hypothyroidism, Conn’s syndrome and pernicious anaemia. My mother is English, my father Scottish and my grandfather from Irish descent. An eclectic Celtic mix of genes to say the least.. If I were a dog, I would probably describe myself as a pedigree mongrel (even though technically I was born and part raised in Scotland).

On a personal level, I have seen the challenges and opportunities faced by my family members and loved ones, when they tell me ‘what it’s really like’ to have a long term condition. My Dad lives with diabetes, and admits he finds this a real struggle at times... During a recent ‘tete- a tete’ about health and wellbeing, I asked him to tell me about his diabetes care, describing his thoughts and experiences.

‘Care should be agreed, not imposed’! Sums up his initial description... and why do they ask me the same questions all time? It’s a challenge to get an appointment as it is.. I would like to go and see my GP/nurse armed with my results and talk about what matters to me!

My Father has a reasonably good grasp of his condition, manages his insulin regime and remembers to take his medications (most of the time). As his daughter, I feel a real sense of frustration and disappointment on his behalf. As a practice nurse, and from a professional perspective, I acknowledge that we have an imperfect system, underfunded, and a general practice workforce stretched to capacity.

I work with people with diabetes everyday, who feel just like my Dad. Some come to see me for a ‘quick fix solution’, whilst others want more information, access to data, and real ‘ownership’ of their health needs. As one of my GP colleagues never ceases to remind me ‘what patients need is a good listening too’. I am now listening... intently....

I am a relative newbie to the twitter community, and was encouraged to contribute by an amazing GP colleague Dr Amir Hannan.

Dr Hannan is a trailblazer who has successfully pioneered patient record access at a nearby surgery. The patients and the team @HTMC are an inspiration, as they are pushing boundaries ( boundaries which need to be pushed in my opinion!) in order to improve health literacy, Self management and ownership of health’ @ingridbrindle is a ‘tour de force’.

In my own surgery, we are currently undertaking survey’s to poll patient opinion, to see if there is an appetite for open access to records. The provisional results look exciting, and promising for the future.....

I love my job, and it’s a privilege to help patients where I can. I am extremely lucky, as my own GP colleagues are amazing, and encourage me to develop my knowledge and skills. Dr Simon Westmerland is our resident GP, with a great passion and insight into diabetes Care.

I have also had the pleasure of working with @andyhersh and @susanmason66 who have developed and designed our local integrated diabetes service in partnership with patients. Two colleagues who I admire, and have worked tirelessly with commitment and dedication to improve local services.

As a practice nurse, I would like to see all diabetes communities think much more radically about new approaches to care, some of which might involve new partnerships.

I believe scarce resources need to move around the health economy and be more responsive to ever changing needs. We all dream of a drug or treatment that may have a ‘miracle’ effect for people with diabetes, but until that day comes we have to continue to focus on delivering the best services we can...

In my view, having access to patient records should become an integral part of a shared journey. I feel increasing the support to people with long term conditions, will enable them to understand and manage their conditions more effectively.

So Dad, what should the future look like? ‘The healthcare team needs to work with me!’ .....My sentiments exactly!

Proactive care, patients and clinicians working together, joint decisions, and training opportunities to learn and grow together are a necessity. Decisions backed by communities like #ourD and inspirational people like @davidcragg demonstrate what care could look like, without boundaries between primary and secondary care...

Wednesday, 21 May 2014

A view from the other side - how one line hurt

Given I've been very vocal about my dislike of how care.data was being implemented, you might think it odd that I'm releasing all of my medical notes about my hospital admission in 2011 on my blog today, but there is good reason:

1. I'm in control - I'm the one that has decided how and what is being shared.
2. I believe things can be learnt from what is written in these documents and I'd like to explore them further with you.

If you haven't read my diagnosis story and how I went about getting hold of my medical records you might want to take a look at those now to get some context for this blog post.

When my hospital notes came through there wasn't any real order or structure to them, so I have tried to group them together into four roughly themed areas:
You can view them all in one folder using the link here if you prefer: All my medical records

I have redacted them to ensure any names and signatures (other than my own) aren't visible and that the medical history of others in my family are blanked out - I'm sharing my history, no one else's!

The main reason for requesting my notes was to understand the reasoning behind the change in my diagnosis whilst in hospital from type 1 diabetes to type 2 diabetes. Unfortunately I don't have any insight into that, but I have gained insight into many other things about my care at the time.

Some of the most notable things (from a people/process point of view) that I've learnt are:
  1. Most of the paperwork doesn't support what HCPs want or need to record.
  2. I feel there must be a lack of education on how HCPs are expected to fill out these forms.
  3. Shorthand and legibility issues are rife within my notes!
  4. Communication was extremely poor.
  5. The healthcare system still hasn't got its head around the idea that patients might want to see their own medical records.
In later posts I will "unpack" my thoughts around those areas, but maybe, if you take a look at the records yourself you might understand what I'm getting at before I post about them :)

Instead, in this post, I want to highlight something I found in my notes that made my extremely angry and upset. As I have already stated, I purchased my medical notes to find out the reason for the change in diagnosis. The notes do not give me that reason, but that is not the reason for my anger or the reason for me being upset. It was what I found written on page 14 of the clinical notes grouping...

The comment that angered and upset me
"11th March 2011: Refer to GP on discharge as possible change to insulin if diagnosed as DT1."

That one line, buried in all my notes, hurt.

If the individual who wrote that note knew the cost of not checking my diagnosis whilst I was in hospital, I would hope they would never do it again.

If they knew how many nights I sat at home not eating...
If they knew how I became fearful of food...
If they knew how, even now, I still have issues with certain foods...
If they knew...

If they knew a simple and cheap GAD test would have changed my post-diagnosis life significantly.

Instead, I left hospital with a 100% categorical diagnosis of type 2 diabetes. I was given absolutely no doubt what-so-ever and unsurprisingly I failed to manage my true condition on Metformin, Gliclazade, exercise and... not eating.

Until that note was written by the DSN, everything in my notes said I had type 1 diabetes.

Both my wife and I were told I had type 1 diabetes and that I would require insulin for the rest of my life.

Everything written after that note said I had type 2 diabetes.

...and so I sit here thinking "Why?" and "What if...?"