NHS selective notes

iwant2asave

Hi,

Has anyone else had experience of NHS selectively choosing what to document to minimise symtoms to justify an earlier discharge from their service?  If so, what did you do?

fyi my case is below for context of the above question :

In my case I had an elbow injury 2 weeks ago that I was initially told after xray was thats its a fracture at the hospital who referred me to vitual fracture clinic - then I subsequently received a call from the virtual fracture clinic to say that it was just a soft tissue injury.  I queried this on the call as to why the hospital said it was a fracture and they said "its hard to tell from xrays".  I  then received an email with information on elbow sprain injury exercises and then a discharge letter selectively stating only some of the symtoms.  All symptoms relating to the bone - such as the popping that I heard at time of injury and the remaining tenderness on my bone have been omitted from the discharge letter to make it sound like there is definitely no bone injury and hence no follow up needed.  I'm trying to work out if I should try and go to a private physio or somewhere that doesnt seem to be looking for an excuse to discharge which I feel is the case with the virtual fracture clinic - My priority is to get it to heal properly and I dont mind paying for it.

Flugelhorn

Might be a case of the X-ray being reviewed by a grown up. 

When we were juniors in A&E, all the x-rays were reviewed by seniors (radiologists) the next day and phone calls were made to people where fractures had been missed or further assessment was needed. Occasionally people overdiagnosed a fracture when it was possibly not and it took some experience to know the difference. 

re info not being included in discharge summaries - I laughed when I saw my discharge summary & MRI referral as it bore no relation at all to my signs and symptoms. I think a lot of the summaries are a bit "tick box" these days. 

Might be useful if you can get a copy of the X-ray report 

DullGreyGuy

If you remain certain its a bone issue why would you go to a physio?

Reading X-rays, Ultra-Sounds etc is a skill, most medical staff have some experience in doing it but others have more experience/abilities than others. One difference I've noted between NHS and Private is often your random registrar is looking at your X-ray whereas in Private practice the consultant rarely looks at the image and instead reads the report provided by the consult radiologist. 

It's likely the registrar in A&E saw a shadow on the X-ray which they believed may have been a break hence in a cautious approach referred you to the fracture clinic. They reviewed the X-ray for themselves and believe the shadow isn't a fracture hence treating it as a soft tissue injury, they review many more X-rays than an A&E doctor and are more likely to be correct. In an ideal world maybe the X-ray would be repeated or replaced with a scan instead but NHS are cost conscious. 

I wouldn't get too excited about what was put on the discharge letter, as long as the original doctor noted the symptoms there is ultimately a record there should you need to challenge them at any point. I'm sure some patients could go on for 20 minutes explaining what happened and what's happened since which could be distilled down into 3-4 bullet points but they may feel critical items have been missed from the monologue. 

Private practice is often different with little to no consideration of budget but at the same time also feels excessive at times, like getting two MRIs at the cost of £1,200 because "your going to be there anyway" but already have a diagnosis for that problem even if it sounds vaguely similar to the new problem.

iwant2asave

Thanks for the replies.

The person at the hospital reading the Xray (I think a Nurse Practioner) who said it was a fracture was at the same time being shadowed by 2 student Drs and he said to them "I have read thousands of Xrays" and proceeded to talk them through the images - I think he said something like "umbrella" shape if I remember correctly when referring the  pattern at the point of fracture.

I am not "certain" that its a bone fracture - I am just nervous in case a fracture had been missed and in case it leads to long term problems.  Maybe I'm wrong but it felt like they wanted to discharge rather than do any kind of follow up and that increased when I saw that they conveniently only included points that suggest sprain and ignored bone symptoms and mechanism of injury (i.e. falling forwards elbow popping was not even mentioned).  My main symptoms I spoke to the fracture clinic was around the bone soreness tenderness and swelling around the bone -  nothing at all relating to the bone was mentioned only soft tissue factors (which had been healing and are mostly healed now).  I am mostly left with bone soreness and inability to straigten or bend fully at the moment (2 weeks post injury).

I wasnt aware I could get a copy of the xray report - is that done through my GP?

Anyway maybe I will give it another week or two and hopefully it will heal naturally without having to do anything other than the recommended sprain exercises.  Thanks for the information.