Friday, 19 October 2012

A Closer Look at Case Notes

Documents contained in a Dott case note folder from Bangour General Hospital: typed case summary; temperature chart; hand-drawn sketch; body examination chart; perimetry chart; and operation chart. Personal patient details have been redacted.

As the end of the second month of our project to catalogue the neurosurgical case notes of Norman Dott approaches, we are reaching the completion of its first phase, which focuses on research and methodology. A large part of this research has been devoted to assessing the contents of case notes in the Dott collections – and one conclusive finding of these two months has been that there is no such thing as a ‘typical’ patient case note, just as there is no such thing as a ‘typical’ patient!

The idea of cataloguing case notes (particularly in such large quantities) for thousands of individual patients may sound a less than inspiring one to someone unfamiliar with medical records. Many people are unaware of the range of information and types of material a case note can contain, as was I before I had volunteered and worked with medical archives. However, on closer inspection, an image of case notes as dry, impenetrable forms packed with incomprehensible abbreviations could not be further from the truth.

Although it cannot be denied that many records in the Dott collections contain typed “forms” (which undoubtedly help to pinpoint the key information that we need in order to write catalogue entries), what is included in a case note folder varies with time and is very dependent on the medical condition (and personality!) of its human subject. For example, in Dott’s early days in Ward 20 of the Royal Infirmary of Edinburgh, many case summaries were handwritten on small notepad paper, and no typewritten forms were used. Other case note files may only contain correspondence after Dott was asked for opinions from general practitioners around the country. The case note files in this project contain a huge variety of documents with a wealth of information for researchers: laboratory reports, operation, examination and anaesthetic charts, medication dosage tables, newspaper clippings, letters, postcards, and examples of handwriting and drawing used to measure the dexterity of patients before and after operation, to name but a few.

Some of the most fascinating and enduring records of Dott’s work are in the form of images, including photographs, slides and x-rays – not to mention clinical sketches made by Dott himself. Particularly interesting are photographs resulting from angiograms (x-rays used to examine and reveal blood vessels through the use of a special dye), an important diagnostic tool for Dott – in fact, he was the first in the United Kingdom to correctly diagnose cerebral arteriovenous malformation through angiogram with sodium iodide dye in 1929, and the first to demonstrate an intracranial aneurysm using angiography in March 1933. Photographs were often produced from x-rays, and were also taken on the ward to show changes in appearance that resulted from medical conditions, or to document the cosmetic results of operations.

Case notes are not only records of medical procedures, they tell stories of clinical discovery, can witness lasting relationships between doctor and patients through correspondence over decades, and reveal individuals’ capacity for courage when most vulnerable. In the completion of a detailed catalogue, we hope to make these stories and discoveries accessible to researchers for a very long time to come.

No comments:

Post a Comment