Making Notes

Sean Murphy *
Administrator, Protection of Conscience Project

Tape recording

Tape recorders can be used to make notes ‘on the fly’ and may be the most convenient way to record an incident during a busy day in class or on the ward. However, you must transcribe the recorded notes because

it is easier to refer to and compare different parts of written notes than to skip back and forth through an audio tape;

written notes can be reviewed by others;

written notes can be consulted while you are giving evidence at a hearing;

audiotapes can be damaged or erased.

Transcription is an exacting and time-consuming process, so it is not wise to let untranscribed tapes accumulate.

The laws about tape recording conversations vary from one jurisdiction to another. Regardless of the law, you should not electronically record a conversation without the prior consent of all of the parties involved. Moreover, you should not tape conversations, even with consent, except in very unusual circumstances. Bringing out a tape recorder will almost always be perceived as an indication of distrust. People may well take offence to it, and giving offence is not conducive to resolving conflicts. (Interviews with reporters constitute very unusual circumstances. See the section on media.)

Materials

In a pinch, notes can be made on shirt sleeves, napkins, matchbooks or Visa receipts. However, a pocket notebook or some kind of bound journal is the preferred medium, and hastily scribbled notes should be transferred to it as soon as possible. Computers and similar devices can be used, but a current backup file should always be kept separate from the device as insurance against hard drive failure or theft. What follows assumes that some form of bound notebook will be used in most cases.

Structure of the notebook

Notes cannot always be made at the time of an incident or conversation. They often have to be written a few minutes later, or even a couple of hours later. Especially when under pressure, people make mistakes when writing notes. They become confused about a date or time; write one word when they mean another; write three lines, and then remember something else that was said between the first and second line.

Much will depend upon your credibility, and your credibility may hinge on the reliability of your notes, including the demonstrable integrity of your note-taking. You can structure your notebook and adopt consistent note-taking habits so that you will be able to explain the construction of your notes at any time. You are then less likely to be confused or shaken by questions about when the notes were written, or why or when corrections were made. [See illustrations]

When to record

Ideally, you should make notes at the time that any incident, conversation or observation suggests to you that your conscientious convictions are in issue. However, you may be unable to do so, as others may be present, or you may be busy. In that case, make the notes as soon as possible thereafter: between patients, at coffee, at lunch, etc.

Notes made nearer in time to an incident will be considered more reliable than notes made later. This is especially true if something else happens between the incident and the note making that might give someone a motive to slant or falsify the record. If you see a patient in the morning and decline to provide procedure X, are confronted by a colleague in the afternoon, and make your notes about the incident in the evening, it will probably be argued that your notes are unreliable because you only made them up as a result of your worries about points raised by your colleague. The same could not be said of notes made as a matter of course immediately after the patient interview.

Of course, if the later conversation with your colleague makes you aware that certain aspects of the patient interview need to be more fully addressed, you can do that by making notes of your conversation with your colleague and of the required clarifications. The original notes of the patient interview should be left intact. This is a natural kind of development that most people will be able to recognize from their own experience.

How to record

Use a pen, not a pencil (unless nothing else can be had). Since these are your notes, you are free to use any shorthand method or symbols you prefer. Make sure your notes are legible, as you may have to refer to them months later.

It may be possible to make some notes during a conversation, without introducing an element of distrust or confrontation. For example, if your preceptor refers to a particular research paper or book, it would be natural to ask for the title or citation and write it down.

What to record

In addition to the date and time of the incident it will be helpful to record the location and names of other persons present.

Notes are notes, not mini-essays. They are used to refresh your memory when writing a detailed account of the incident later, when discussing the situation with someone else, or when giving evidence. Notes should primarily record key information.

In cases of coercion or discrimination arising from conscientious objection, it is likely that what you said or what someone else said will be of great importance. Special attention must be paid to making notes of the verbatim content of conversations. Consider the following dialogue:

Pt:   "If you won’t do it, refer me to someone who will."

Dr:   "I’m afraid I won’t do that, either. If I help someone to do something that I think is wrong, I would share responsibility for it."

Pt:   "How could you be responsible?"

Dr:   "It would be like me helping someone to rob a bank by giving him the plans of the building and directions to get there."

Pt:   "Bank robbery is illegal. This isn’t."

Dr:   "It isn’t illegal. But I consider it to be wrong, so I don’t want to be involved with it."

If later asked to write down what was said, or, at a hearing, to relate what was said, it is very likely that the parties to the conversation would produce accounts from two different perspectives in the following form:

Pts. Account	Drs. Account
She said she would refuse to help me find another doctor because what I was doing was wrong, like bank robbery. If she referred me she would be just as guilty as me for doing it. She wouldn’t help a bank robber, and she wouldn’t help me.	I told him that I would not amputate a healthy limb, nor refer him to someone who would. I explained that it would be wrong for me to refer him to someone else, and used the example of aiding and abetting a bank robbery to make the point.

The problem is that, while these paraphrases are honest interpretations of what was actually said, they fail to accurately convey the full sense of the exchange. Important nuances are lost. Someone hearing the patient’s account might conclude that the physician was moralizing or overbearing, and there isn’t enough detail in the physician’s account to preclude this conclusion.

The example should suffice to illustrate the importance of making notes that allow a conversation to be reproduced as nearly as possible in its original form. This enables one to draw conclusions from what was actually said, rather than from what could be self-interested paraphrases of a discussion.

You can use a personal shorthand when making notes of a conversation, but you should make the notes in the form of the dialogue, including important statements or phrases verbatim and enclosing them in quotation marks. If you are not sure that your record is exactly right, word for word, you can use the following form (drawing from the example above):

"Bank robbery is wrong. This isn’t."[WTE]

WTE signifies, "or words to that effect." It means that you have reproduced the actual words as best you can, but, if there is a minor error in your recollection, you have accurately conveyed the meaning.

Recapitulation

In some cases you may be able to make a few notes at the time of an incident, perhaps recording several different things very briefly. You may not be able to make detailed notes until later. At that time, you should make an entry headed, "Recap," and, referring back to your brief notes, expand them to capture all of the relevant information. If you are interrupted, continue the recapitulation at the next opportunity, again identifying the entry as retrospective.

Narrative expansion

Using your notes, an important incident or conversation should be expanded to a full narrative while it is fresh in your mind, including details about manner of expression, emotion, and other things that one might not include in notes about the essentials. The expanded narrative may prove to be particularly important later. You can use a tape recorder to dictate an expanded narrative, but be aware of the need to transcribe the tape and the time that will be required to do so.