Medical Record Keeping as an Art – Improving Accuracy and Reliability
Can medical record keeping be an art? This article examines this highly significant question in the light of ancient medical astrology
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Any mundane activity can be made more interesting if it can be artistically done. That is to say, a creative spark added to a routine activity breeds a new interest in it while also bringing about better outcomes. This is something that applies to even a process such as medical record keeping. In the course of providing medical records review, we have come across artistically and systematically maintained documents as well as many disorganized and confusing sets. Needless to say, the former are a pleasure to deal with while the latter make the entire review process a real battle. A Case of “Casebooks” and Artistry Speaking of artistry in medical record keeping, the recent Casebooks exhibition in London held in March – April 2017 was a thrilling experience to many. This exhibition investigated one of the largest surviving sets of medical records (casebooks) in the world. We are speaking about the almost 30,000 pages of documented physical symptoms, horoscopes and religious speculations attributed to the astrologer–physicians Simon Forman and Richard Napier. These documents comprise some of the most extensive private medical records in history from before the year 1700. The 64 leather-bound volumes contain thousands of consultations spanning nearly forty years relating to general health, disease, and other problems of the body and mind. They also contain questions about romance, sex and marriage as well as job prospects and economic, political and environmental issues, all artistically documented. Six artists who were invited by the curators to take inspiration from Forman and Napier’s curious practice of charting showcased their artworks in the exhibition. They worked closely with the University of Cambridge’s Casebooks Project that aims to engage artists and audiences with questions of interpretation of the astrologer-physicians’ manuscripts within an ecosystem of contemporary media and practice. These six artists incorporated material from the casebooks wherever it provided meaning. They used the casebooks as a sounding board for their art practice, engaging actively with the various layers of the records and the encounters they document. Medical Astrology – Adding the Elements of Romance to Medicine Medicine and astrology were related disciplines. The ancient medical system Medical Astrology associated various parts of the body, diseases and drugs as under the influence of the sun, moon, and planets along with the twelve astrological signs. Medical Astrology flourished most in Europe in the late medieval and early modern periods, 1450 – 1700. Astrologers such as Forman and Napier assigned zodiac signs to rule over parts of the body,
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planets to rule over organs and systems, and planets to rule over diseases and drugs. They computed the locations of the heavenly bodies and mapped them on a chart before making a judgment. Records of astrologers’ consultations exist from at least the 15 th century. However, only few examples are extant that predate Forman’s, and they do not contain much medical content. Maybe other astrologers in 17th century England such as Nicholas Culpeper (1616-64) may have had as many clients as Forman and Napier had, but those records are lost. The University of Cambridge has been digitizing Forman and Napier’s archive for public access for the past 10 years. It is available free of charge and provides for fascinating reading. It was A.L. Rowse who referred to Forman’s records as “casebooks” in his 1974 book on Simon Forman that popularized the astrologer’s papers. In the Casebook project, this name has been retained to signify “medical records.” It was around the year 1750 that doctors borrowed the term “casebook” from lawyers. In the subsequent years, hospitals began to keep “case records” that signified the promotion of systematic and objective medical practices. Forman and Napier’s case books predate modern medical records. Forman’s and Napier’s medical records are highly organized, artistic and comprehensive compared to other early modern medical records. The Beauty of Medical Records •
In early modern England, medical records ranged from a handful of cases on scraps of paper to the wonderful collections of Theodore de Mayerne, the famous Royal physician. Mayerne has to his credit more than 3000 pages of documentation that show around 1000 of his cases from 1603 – 1653.
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The most comprehensive medical records contain details such as name, date, complaint, history, diagnosis, remedy/therapy, and payment.
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Some of the medical records have been created at the time of consultation whereas some others have been written retrospectively.
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Mayerne’s medical records are intricate narratives that are beautifully written. There are sketches of trusses, wigs and syringes in the margins.
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Medical records ranged in format from small pocketbooks to impressive folios.
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A practitioner in Shrewsbury, Dr. Barker, whose casebooks exist in fragments now have recorded instructions for medical record keeping. These instructions include noting down details such as the patient’s name, day and hour.
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The records of Forman and Napier, just as other medical record books, full case histories or account books were used with the objective of collecting information. The significance of these records is in that they all document a detailed process comprising conversation, careful observation, judgment, and collection of the required material in a written form. The Latin tradition labeled the surviving medical records as “cures,” “diaries,” or “observations.” Mayerne termed his records “observations” and “ephemerides” meaning day-to-day records. English collections were named “bosom book,” “book of judgments” (both Forman’s), “book of cures,” and “book of experiment.” Some of these astrological and medical records contain indexes of the names of patients, diseases, or both. Ancient to Modern – the Evolution of the Medical Record Early medical practitioners began keeping records later than medical astrologers, and these can be categorized as follows. •
Account books. Names of clients and their payments for prescriptions or treatments.
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Case histories. Some of these recorded advice to patients about diet and recipes; some others were testimonials of remarkable or successful cures, lessons for surgeons or autopsies.
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Observations, which were collections of cases published by medical practitioners.
We can see how these ancient medical records evolved into the modern patient records that form a permanent account of a patient’s illness. Medical documentation needs to be accurate and clear to ensure effective communication between patients and healthcare professionals.
History, physical examination, diagnosis, investigations, management,
follow-up and referral, patient information, and consent comprise the key information to be documented in the patient chart. Good note taking is essential and this is where comprehensiveness and artistry have a significant role to play. Precision is an important component of art forms whether painting, sculpture or any other. It is this accuracy that contributes to its artistic excellence. Other important factors are clear vision and a solid bringing together or organization. These very same features also contribute to the creation and maintenance of the perfect medical record.
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