BJJ News
Editorial
Tick boxes, checklists and proformas takes remarkably little skill, and even less thought, to put a tick in a box. It can be accomplished by any competent three-year-old who can lay hands on a writing implement and summon up a modicum of coordination. Why is it then that so much emphasis is placed on tick box forms in modern practice? Once upon a time, these didn’t exist: doctors wrote up their notes, usually concentrating on the important relevant findings, and nurses wrote a narrative description of the patient’s care and response to treatment. Of course, this meant that those looking after a patient had to understand what was important and what was unimportant. Have matters really changed so much? Now, when a patient is admitted to hospital, they become the subject of a booklet in which page after page of questions are to be answered by means of ticks (or a binary ‘yes’ or ‘no’). Because the booklet has to be comprehensive it is seldom tailored to the patient’s condition and many of the questions are irrelevant to the individual concerned. There is, consequently, the potential for key features of the patient’s history or care to be subsumed in a morass of irrelevant information. Just how much thought goes into eliciting a response to each question? Because of the number of boxes to be filled it seems inevitable that the concentration either of the practitioner or patient may waver, but not, one hopes, at the point where a key question is being addressed. There appears to be a view in some quarters that once all these questions have been answered, or rather that all the boxes have been ticked, a full picture has emerged of the patient’s history, subsequent care and outcome. This is less than convincing when one comes to analyse the records at a later date and particularly in cases of personal injury or alleged negligence. I am told by m’learned friends that a signed consent form merely indicates that a discussion has taken place but does not
It
indicate the nature of that discussion. How much less does a tick in a box indicate the response to a preset question? I am not aware that this has yet been tested in law, but when it is I am not reassured of a positive outcome. A tick most certainly does not indicate consent. Further problems arise when attempting to retrieve information from such forms. The information that can be derived is entirely dependent on the structure of the question. There is no flexibility to enter information that might be relevant but does not form part of the question. Indeed, to go into detail when there are so many questions to be answered might be perceived by those administering it as merely prolonging the process, and as such undesirable. So why do these forms exist? My suspicion is that someone in managerial office feels that such a document is comprehensive and, indeed, ‘ticks all the boxes’. It would be cynical to think that as the level of training and education in the NHS drops, practitioners of all sorts are less capable of assessing a clinical problem accurately thereby necessitating such a structured format. A proforma also has the effect of reducing both practitioner and patient to the status of automata and, en passant, probably detracts from the continuing education of the doctor or nurse administering the form neither of whom has to think to formulate the relevant questions. Of course, by being binary, the data generated is much easier to analyse by those without any clinical training. Fortunately, the failure to implement a nationwide NHS IT system has meant that we are not yet fully exposed to electronic health records. When they inevitably arrive, it is likely that the situation will deteriorate, to the detriment of patient care and the intellectual processes of those who have to administer them.
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