The condensation and recording of information Summary and formulation

The skills required to produce summaries and formulations should be acquired early on in professional training, since they are central to the process of getting the information about the patient into a form which facilitates the making of decisions and the allocation of priorities for actions. Useful preliminaries to the writing of both summary and formulation are the preparation of a problem list and a lifechart; how to prepare these should also be covered in the early stages of training. The summary for an individual patient should be more or less the same whoever prepares it, since it should be a simple record of what is known, arranged under conventional headings. A 'telegram' style of writing is acceptable for the sake of brevity. In contrast, a formulation should be written as a grammatically correct narrative, and there is no necessary expectation that two different clinicians using the same summary about a patient would arrive at exactly the same conclusions in their formulations. This is because a formulation is an attempt by the writer to understand, and therefore to some extent to interpret, what has been influencing (and perhaps causing) the feelings and behaviour of the patient, and what relationships might exist between life events, illness, and contact with medical services. In other words, the writer is trying to tell the story of the patient's life and development, albeit very briefly. The complementary story of the episode of care will be clarified by clearly written problem lists placed in the case record at various stages. These serve both as reminders for action, and as a way of assessing progress when re-examined later.

Like the rest of the written medical records, the summary, formulation, and problem lists should be regarded as being as much for future readers as for the present carers. A clearly written summary and a well-argued formulation recorded in the case records will ensure that the reasons for treatments and decisions to do with the present illness are clear, and will be of great help to others if the patient has to be assessed in subsequent episodes of illness.

Summaries and formulations written by psychiatric members of a multidisciplinary team should be freely available to all the team, so that they can be discussed before the meetings at which a diagnosis is agreed and care programmes are set up. But it is not usually appropriate to send summaries and formulations made for hospital and team purposes to general practitioners or to consultants in other specialities. Specially written and shorter letters are best for this, taking into account the possibility that the patient or family may gain sight of, or even be shown, documents about them sent to other medical professionals.

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