Editor’s view
===============

* James P. Waddell

My Editor’s View was late for this issue. I received numerous reminders from the people at CMA Media that the deadline for the piece had passed — a delay that as an editor I would not tolerate from other contributors to the journal! Why was I late? On reviewing the activities in my office over the last 2 months, I can identify a number of factors that would contribute to this uncharacteristic problem with meeting a deadline.

There are the usual time-consuming elements that go with academic practice — committee meetings, preparation of lectures, checking the proofs of manuscripts, etc. However, most of these things can be easily dealt with in a properly scheduled day or week. Although time consuming, they are an inevitable part of academic surgery and can be planned for and accommodated relatively easily.

The real problem, as it turns out, is patient-related correspondence. I am sure I am not alone in noticing the increasing volume of paper that crosses my desk relating to patient care. It starts with the initial request for consultation by the referring physician — this letter (or fax) has to be read and a decision made about the suitability of the referral. The referring physician has to be contacted or the patient contacted directly, usually in writing, to confirm the date and time of the appointment. This correspondence includes requirements such as the results of recent laboratory investigations, x-rays, etc. This information then has to be sent to the clinic in a slightly modified form to ensure an appropriate booking for the patient for assessment.

After the patient is seen, a letter has to be written to the referring physician outlining the findings, the details of the discussion with the patient and the decision with regard to patient disposition. If further investigations are required, these are usually the responsibility of the consulting surgeon, necessitating further forms to be filled out accurately and bookings for these investigations confirmed.

If a surgical booking is made, the volume of paperwork goes up exponentially. Consents must be obtained and witnessed by the treating surgeon — consent for surgery, consent for blood transfusion — and various types of literature regarding the procedure must be explained. Orders have to be written, consultation requests completed and discharge disposition decided before admission.

Two to 3 weeks before the planned surgical procedure, the patient will be seen in the preadmission facility usually in consultation by an anesthesiologist and by representatives of other appropriate specialties. Consultation notes will be written and sent to you, the consulting surgeon, to add to the patient’s chart.

The patient is admitted for surgery, the procedure performed and the patient discharged from hospital at the appropriate time. During the time in hospital, progress notes will be made, orders written, discharge disposition confirmed and follow-up visits planned.

When the patient is discharged from hospital, however, the paperwork does not stop. There is a letter to the referring doctor confirming the events around the admission, the hospital final note or discharge summary, confirmation of pathology reports — the list continues.

More and more patients now have some type of supplementary health insurance covering short-term disability, long-term disability, mortgage insurance — the number and complexity of these forms is bewildering as the insurance companies require more and more detailed information about the patient before the patient can receive the benefits to which he or she is entitled.

It is my impression that the volume of paperwork is not only increasing but the speed at which it must be done is increasing as well. Same-day admission, expedited discharge and rapid turnaround times in order to increase the volume of patients treated in any given period have resulted in marked compression of the time frame available for the necessary paperwork that accompanies each patient’s interaction with the surgeon or the hospital.

Some years ago, people thought the solution to this problem was the “paperless office” — for most of us this remains an elusive dream.

So that is why the Editor’s View was late this month — I promise to return to more substantive topics next time around.

## Footnotes

*   **Competing interests:** None declared.