Missing medical records: an obstacle to archival survey-research in a rural community in South Africa
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Date
2013
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Unisa Press
Abstract
Keeping good quality medical records is an essential yet often
neglected part of a health-care practitioner’s workload. In South Africa, by law
all health care facilities are required to retain medical records for a minimum of
six years after the cessation of a patient’s treatment. In an archival survey that
was attempted in a rural community in South Africa, only 39% of the records
that were requested were located. The procedure that was followed in order to
obtain the records to be included in the survey is briefly described in this paper,
highlighting the challenges experienced in four district hospitals in this community.
The phenomenon has serious implications not only for the quality of healthcare,
incidence of iatrogenic injuries and the future of the health-care practitioner’s career, but it also impacts on the ability to conduct
research to inform practice. An aspect that is not often considered is the impact of poor record keeping on the research and teaching
component of the broader medical profession.
Description
Keywords
Medical, Record keeping, Archival research
Citation
Wegner, L., and Rhoda, A. (2013). Missing medical records: an obstacle to archival survey-research in a rural community in South Africa. South African Journal of Physiotherapy, 69(2): 15-19.