Thirty years ago prior to setting up practice, one of my preconditions was that we would immediately institute record keeping with A4 patient folders and the use of the SOAP system of clinical notes. From 1984 to 2000 this paper system maintained all clinical records, as well as specialist reports. In 2000 computerisation completely replaced folders and fraying A4 pages; thousands of sepia coloured files remained stacked in rows of metal shelving.

Now after three moves of premises and 14 years since the last paper record was written, the owners of our previous practice file room, the HSE, have asked us to move the lot. This is a reasonable request as new occupants of the building will need the space and the files also pose a confidentiality issue.

Faced with the task of properly dealing with many thousands of files, a plan of campaign was put in place. Research revealed guidelines applicable for the retention or disposal of clinical records in general practice. The most useful source is the MPS (in lieu of the long awaited Health Information Bill). Here we discovered the minimum retention periods for patient records: eight years after last treatment or death for an adult; for children; until their 25th birthday or 26th if the person was 17 at last entry or eight years after the child’s death; maternity records must be kept until 25 years after the birth of the last child and for a patient with mental illness – 20 years after the last treatment or eight years after the person’s death. 

We decided to extend the retention time for files in which we found records of legal proceedings. Files to be destroyed must be shredded or incinerated and a confidentiality agreement must be in place with any outside contractor for the destruction of files.

Two reliable and patient young men were contracted to extract each file and note the details on an Excel database and box the folders according to type and date for retention or for shredding. This database is now available if we receive requests for information on retained files. We were glad to discover that at least half the files are due for destruction and that the boxes with retained files will fit into storage space in the new practice. Each year that passes will see another cohort of files which may be shredded.

So much for the procedures, guidelines and many hours of work entailed by this project, not to mention the considerable cost to the practice; but let’s think of the human side. One evening I began to randomly pick files from the boxes which were temporarily stacked there. Some files were fat and frayed; others were thin and still seemed crisp and new after all the years. Some contained many refill A4 lined pages of handwriting but a few had only one entry; it struck me that each entry in each set of notes represented some part of the narrative of a life: “Asthma worsened, coughing at night, cannot play football despite salbutamol... bilateral wheeze, peak flow 200, temp 37, no distress at rest... exacerbation of asthma... add beclomethasone 100 2bd and see if no better.” A recording of a critical time in the life of a talented footballer 12 years old but who didn’t quite make the grade into English professional football.

Another file from 1984 brought back memories of a cheerful old lady who had been a street trader all her life and developed terrible rheumatoid arthritis before the advent of modern DMARDs. Gold injections were recorded by the rheumatologist and my many prescriptions for NSAIDs must have caused her upper GI discomfort and very little relief from her pain and stiffness. She was not a complainer. After all these years I realise that I am smiling when I remember her personality and positivity. 

Thousands of interactions are recorded in scanty SOAP style in my untidy, looping scrawl. Records of childhood vaccines, notes about another suicide attempt by a depressed alcoholic man, clinical details of the last case of whooping cough in the practice (the baby is now a doctor), the records of palliative care house visits to an old soldier who died with the same dignity with which he had lived. I could fill pages and volumes with short snippets or longer narratives concerning the people whose lives are represented (in small part) in the contents of these bulging boxes.

A Leo Tolstoy or a John Banville might populate several epic novels from just a fraction of what is represented by these relics of an outdated information technology and the thousands of lives recorded within. Nevertheless, it will be a relief when they are all properly referenced and stored or carefully shredded. Ars longa, vita brevis.