Query
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Once every two months it happens, and now it's my turn: I get to review the charts of one of my colleagues. Of course I think selfishly, not of the reviewee who has to submit to scrutiny. No, I think of myself, of how uncomfortable it is to view the note-taking blemishes, omissions, and outright errors and then to have to formally comment upon them in the open forum of our review committee.

![Figure1](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/175/7/836/F1.medium.gif)

[Figure1](http://www.cmaj.ca/content/175/7/836/F1)

Figure. Photo by: Fred Sebastian 

You never really know the people you work with until you read their charts. My quarry this time was a horrible note-taker, a jotter, really. His histories were a line long and his physical exams consisted of a single abbreviated phrase: “PE normal.” His lab results were thrown into the back of the chart in a completely random order. His Cumulative Patient Profile hadn't been updated in, as far as I could discern, approximately five years.

Now, I know this doctor is better than the paper tale. He's excellent at hallway consults, and when he himself asks for help he speaks clearly and concisely, providing a succinct package of history and exam and investigations. In fact, he's renowned for his feedback, pointing out things left undone, questions left unasked.

But based on the evidence of the record, my friend looks shoddy. Not a little shoddy, not something I could sugarcoat, but messy, erratic and haphazard. And I had to tell him this.

I wondered: Do I tip him off before the committee meets? Or do I wait, and tell him in the designated forum? I struggled with this. I wondered what a friend would do, and then I wondered what a responsible physician would do, and I came to two very different conclusions. A friend would pre-empt the committee, a responsible doctor would wait. So I decided to wait until the forum, for it came down to this: Should I be worried about losing a friend, or should I instead help my friend be a better physician?

The committee meeting started. After the chair passed the floor over to me, I wasted no time. I stated that I was shocked at how unkempt my friend's charts were. I listed over a dozen sequential instances of my random chart-picking that had the “PE normal” phrase included in the most recent chart entry. I stated that, from a detailed read of several of my friend's notes, all I could discern was that the patient was seen. What was done and what was diagnosed was another matter. I softened my next blow somewhat by saying that I was certain my friend could understand from his own shorthand what his encounters were all about, and that he probably knew the medications and chronic health conditions of his patients, but that no person who picked up his charts would have that power.

I could tell that my news was not welcome. The room was silent, my friend's face drawn and red. I used that opportunity to say that it was my opinion that my friend was a far better doctor than his notes made him out to be, and that if he were a little more diligent in his note-taking he would benefit both medicolegally — for he was wide open to litigation under his current system, or lack thereof — and perhaps the process of writing a good note, one born of thought and deduction, could make him an even better doctor.

I had three options. One was to lie and say that everything was fine, another was to say that there were problems but that everyone has the same problems and that my friend was no exception, and then there was the truth: that my friend took bad notes. I figured that my friend wouldn't like hearing my findings but that it would do him some good. I also thought that old cliché about how if he were really my friend, he would hear what I had to say and remain my friend. But it's been two months and we haven't spoken. I haven't called or initiated contact because I thought he needed some time to come to terms with what I said, so I left it to him to come to me. But now I feel an inertia in which I'm dreading what he'll say to me, and so I'm making excuses not to come into contact with him. Isn't that ironic? I started off worrying that I'd alienate my friend by reviewing his charts, and now I'm the one avoiding him?

— *Dr. Ursus*