Books of life, death—and what comes in between

I registered a death recently.

I had to make an appointment, which seemed a rather formal business. The registrar sat behind a computer. She stood up and we introduced ourselves. It would take about half an hour, she explained.

It was a surprisingly dignified occasion. She unfolded the death certificate from its familiar brown envelope, laid it out on her desk, and studied it carefully. I thought of the hundreds of certificates that I have quickly filled in and torn from that orange book in my desk drawer. We steadily worked our way through a series of questions on her computer. When that was done, she took out a fountain pen and recorded the details in her register, in black ink. Then she asked me how many copies I wanted.

I had assumed that they were certificates in their own right, but she explained patiently that these were but copies, showing me the wording: “Certified copy of an entry.” The register was the reality, and the certificates—despite all the computer entries—no more than copies of that entry in the book. They were duly printed out on the official paper, which was watermarked and crown headed. My little ceremony was over and I went back to the surgery, thinking about the importance attributed to the handwritten record.

Enjoyable and distinctive as they are, I have no sentimentality about our old notes. We often talked about our policy of entering everything into the computer while also maintaining (more or less) the Lloyd George notes. Anyway, as a result in our practice the written record is no longer fully reliable. But curiously, it's as if some of us don't yet feel able to put our complete trust in the computer.

This is interesting, as we've just jettisoned what was thought to be an essential part of the practice—the appointment book. This recorded what's happened in the past and who'd seen whom. It also predicted the future, foretelling who was going to see whom. A handwritten page, open whenever anyone was consulting. And when the surgery was closed, so it would be too. Hardly surprising then that it wasn't just receptionists who were anxious when the large, black backed book went.

“Going paperless” is, of course, far more complicated than the simple phrase suggests. Still, it represents an ideal to work towards for many of us in general practice. But my visit to the registrar had me thinking about the significance of the handwritten word. Perhaps we need to be reminded of one crucial part of our job—that of transcriber, of recorder, as the keeper of the story. In the book A Fortunate Man by John Berger the GP “does more than treat them when they are ill; he is the objective witness of their lives . . . the clerk of their records.”

This is an important part of our work, by which the subjective experience of our patients is translated into objective fact. It is a duty which is unspoken but expected.

No doubt, all this can be achieved through modern information technology. And there's no need for us to do this any longer in black ink in a book.

Still, it is interesting that words on paper are referred to as hard copy. My visit to the registrar leaves me wondering about a continuing, deeprooted need for the reality of the handwritten word on the page of a book. At least, for the important things.