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SCRAP CPA and ‘Non CPA’ DOCUMENTATION

Comment 6th July 2010

Nhs workers have to fill in reams of paperwork for every patient and every contact. The paperwork ranges from moderately useful to useless/inappopriate to ridiculous. Practitioners can't select useful stuff and bin the rest. Every patient has to have everything.

The same documentation has to be used by extremely diverse professionals treating diverse groups. For example, the paperwork has lots of stuff on risk – appropriate for some seriously mentally ill people, but has to be used if treating a mildly anxious 6 year old. The forms aim to be exhanustively inclusive: hence the 'religion' box offers the options of 66 possible religions including Divination., 4th Way, Satanism, Voodoo, Free Daism – but not Buddhist or Catholic…. And 180 languages – not including Cantonese! Important relationships include 'polygamous partner' – but not Godparent. My point is not to make the form even more exhaustively inclusive, but to illustrate the idiocy nof trying to capture every possible answer in a tick box.

These tick boxes are trivial but they point to the ideology:

1) Professionals cannot be trusted to do assessments and make their own minds up about what to ask, and how to guide the assessment. Everything is reduced to a box.  

2) For Gawd's sake don't offend anyone by missing anything out!!

Why does this matter?

These forms are cumbersome, time consuming and divorced from actual practice.

They do not improve care – rather they try to reduce the complexity of good assessment, formulation, diagnosis and treatment into neat little boxes.

Enforcing full completion of the forms is expensive and time consuming,

Training in use of the forms is expensive and time consuming. 

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