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Investigating older people.

Editor – Your editorial (Clin Med, July/ August 2003 pp 301–2) and the article by Mann and Williams1 are timely. To a bacteriologist who many times had to analyse series of patients’ notes the varieties or even absence of structure was an unnecessary burden. But who does the recording also matters. Over 50 years ago as a house physician puzzling over a patient, I referred to his notes from an admission twenty years earlier. They were beautifully and intelligently written. Their student author was Janet Vaughan, by then a distinguished haematologist. As you say, chronic patients’ records are particularly difficult. In the Rheumatic Unit at the Canadian Red Cross Memorial Hospital, Taplow, children with Still’s disease remained in hospital for many months. Generally this would have meant an unwieldy mass of notes which, even if legible, needed weary searching for whatever nuggets they might contain. At Taplow the notes, rigidly controlled by Eric Bywaters, the unit director, consisted of semi-formalised information on a series of charts sellotaped into a long horizontal scroll. The senior registrar’s job was to impose the Bywaters doctrine onto the daily practice of a series of house physicians. But finding data and following a patient’s course was quick and easy. More recently, when involved in an intensive surveillance of hospital-acquired infection,2 I hoped that computerisation of notes would help. It did, but not much since every hospital had a different system. As Mann and Williams suggest, there is still a long way to go. Developing good systems is difficult but whether records are computerised or not, the following quotation3 (from memory) applies,