Navigating ‘not doing’ in primary care: could more explicit guidelines on record keeping help to ease clinician anxiety?

Electronic health records (EHRs) serve several key purposes: they remind healthcare professionals (HCPs) of consultation details, support continuity of care by sharing information, and provide evidence of care quality or potential deficiencies should clinical practice be scrutinised.1 As primary care (PC) professionals develop record-keeping skills, they may be influenced by preregistration training, advice from peers and mentors, observing others’ record entries, audit feedback, and published guidelines. Given the various ways these skills are acquired and the lack of a widely adopted gold standard, documentation practices differ across UK PC. This inconsistency may complicate record interpretation for multidisciplinary healthcare teams (MDTs), complaint investigators, and patients who view them. There are increasing concerns about medical overuse, including over-prescription, overdiagnosis, unnecessary referrals, and a recognition of the harm it could cause patients. Medical overuse is complex, driven by time pressures, care discontinuity, patient expectations, team culture, misuse of guidelines, fear of complaints, and peer criticism.2 HCPs often worry more about being criticised for ‘not doing’ than unnecessary interventions, despite the risks associated with both scenarios.2 Anxiety over patients’ decisions to ‘not do’ something, along with fear of reprisals, may fuel defensive practices. Robust record keeping could be an important facilitator in reducing clinician anxiety and decreasing medical overuse. The concept of ‘not doing’ in PC is more nuanced than it might initially appear. While it suggests inaction, consultations are inherently active. For example, advising patients to watch and wait is rarely passive; it ideally encompasses careful consideration, communication, and shared decision making (SDM), offering patients the opportunity to voice their concerns and nurturing therapeutic relationships. In this article, ‘not doing’ refers to decisions that do not involve contemporaneous prescriptions, treatments, referrals, tests, or diagnoses, acknowledging that these decisions are a complex, active therapeutic process.