21 December 2006

Don't write everything...

More christmas drinks...

I met a social worker from another town. Seems like she challenges expected practice. Had a nice chat with her...

One thing that stuck out. She was asked to do a social circumstances report for a MHRT with about 3 days notice. On her first visit to the patient she decided he was too sedated to engage properly, she told staff she would come back the next day and she hoped his medication would allow her to talk to him properly. This didn't happen - his meds were still too high, and she couldn't get the information she needed from him.

The report she wrote was therefore very brief. It mainly said that she had been unable to get sufficient information to be more comprehensive. She then came under some pressure to explain why she hadn't gone into full detail (although she had explained this in the report).

It struck me that very often people are expected to deliver comprehensive reports, but also very often it is difficult to be so comprehensive. Social workers and psychiatrists and others use their professional experience and judgement to fill in the gaps, which is of course what they're trained and paid to do. The problem is twofold: that this gap-filling process is fraught with difficulty (it's hard enough to assess how people are, let alone guess what fits in the gaps); and the second problem is that whatever is written could well be referred to for years after.

These two small problems combine into one big problem: the guesses people make with the best of intentions then become the 'truth' that can dog the patient for years to come.

What a good idea then to produce a minimalist report that leaves gaps where there are gaps - at least there are fewer chances of making mistakes that could affect people for years...

Another way of saying what I'm trying to say: when we work with people with mental health problems, in fact whoever we're working with, there are bound to be gaps in our understanding and assessment of them... what we need to do is acknowledge these gaps and let them be reflected in our reports, instead of trying to be comprehensive and ending up misrepresenting people.

A resolution for 2007? Shorter reports, more gaps?

2 comments:

malcolmroff said...

Good Grief - do we need more people like you around or what. Great Post.

Anonymous said...

Why patronise the mentally ill? We can speak and advocate for ourselves.