Should the record of a conversation be 'Signed Off' by both parties ?

There are some discussions, or conversations, between clinicians and laymen (patients or sometimes the relatives of patients) which are considered so important that the clinicians are told to document the conversation.

The Independent Review of the Liverpool Care Pathway commented in its section 1.29 that 'the Review panel ... was also consistently shown, and all too frequently told of, instances where the form had been filled in wrongly - recording discussions with relatives or carers which they denied had taken place, or including observations that the relatives or carers believed had not been made. The Review panel appreciates that a record can only summarise the perspective of its author, and that a claim of false recording may be made because of a lack of clear communication between the clinician and the patient, relative or carer at a very difficult time for them'.

My question - I would appreciate some more comments about this - is, if a conversation is considered so 'important' that a clinical policy or protocol requires that the conversation be formally documented, then should the record of the conversation be shown to the layman, and 'signed off' by the layman, unless this is not possible for reasons of 'opportunity' ?

I originally phrased the question like this:

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Now, I am aware to an extent of the various hierarchies, machinations and power struggles which afflict the NHS - but it seems obvious that if a 'protocol' considers it important that a conversation be documented, and bearing in mind that a conversation involves 2 sides, the documentation should if possible be 'signed off' by BOTH sides.

So if a hospital has a policy that 'a discussion about such-and-such with relatives should take place and be recorded', then unless something physical prevents this from happening, the note of the discussion should be read by whoever didn't write it (it would probably be written by a clinician) and then signed by that person. So a record of a conversation and its content, should be signed within the notes, by the clinician(s) and the layman(men).

This strikes me as blindingly obvious.

Clearly you can't do that with a phone call, at the time (and I'm not suggesting that all calls should be recorded): but lots of EoL interactions are ongoing, so there would be plenty of opportunity to show what has been recorded about things like conversations to the relatives involved, and to ask them to 'check you agree this happened' and to 'sign it off'.

It is clear that this is much less easy to achieve for electronic records, so probably this would need the retention of some written records: however, the Neuberger review seems to want written records for exactly this type of thing (sections 2.19 and 2.20).

This perhaps seems less obvious to 'the NHS', because the NHS likes clinicians, and in particular the senior medic, to 'control and sign off everything'.

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I asked a layman, who I shall call 'Tim' here, and he came back with:

'Your logic certainly makes sense. All noted conversations should be signed off by both parties.'

I also asked a Civil Servant who came back with:

'I agree with the logic of both parties signing off conversations but I'm also concerned about the practicalities, and the effect it might have on relationships. If the end of life care experience for relatives becomes even more bureaucratic, or they get the impression that professionals are constantly acting defensively, that could be damaging to. It's a tricky one to balance, I think.'

So I went back to Tim, with:

'But I think being asked to confirm that a record of a conversation is correct, is exactly the opposite of 'defensive behaviour' by the clinicians - how about you ? I think more talking and especially more inclusiveness, would actually improve 'relationships'.

I don't actually want more bureaucracy, I'd like tighter integration between clinicians and laymen, and I suspect that if clinicians had to discuss more of what they had written with the laymen, it might concentrate their minds and get them to stop recording unnecessary stuff, and to record important stuff rather better ? But I'm not sure, about that.'

Tim came back to me with:

'100% agree with your take Mike. A double sign off does improve openness and also sharpens clinicians thought. There is no 'defensiveness'.'

What do people think - to improve accuracy, and to prevent possible confusion about 'the meaning of our discussion', should laymen read and then counter-sign all clinically-generated records of conversations between clinicians and laymen, wherever this is possible ?

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