The problem is that registrars, as trainee consultants, only stay in one particular hospital for 6 months and then move on to experience another area of expertise before settling on what they want to specialise in, so are totally reliant on whatever their predecessor has put in the notes.
You are also very much at the mercy of the clinic staff who are the ones who fill in the forms according to what the Consultant/Registrar wants done next, e.g. follow-up in 6 months with x-ray on arrival.
I and a few colleagues are currently battling the falling standards of patient care on the admin side of our department since a new "manager" conned her way into her post.
She may have been a good secretary in the private sector, but she is a moderate NHS secretary and an even worse manager. All the secretaries that have been employed by her are all taught only half of the job, none of them know that info has to get onto the notes - even if it means trekking to the other side of the hospital to do it.
Nor do they bother to check the system to see whether or not the clinic staff have actually actioned what the Consultant/Reg has dictated in his/her clinic notes. All they seem to do is sit and type and take long lunch-breaks. There is a hell of a lot more to the job than that, but we cannot make the stupid woman see it.
My own strategy is now to use my position as Clinical Director's secretary to highlight the gaping holes in her knowledge by posting directives from my boss instructing secretaries in the correct procedures. Guaranteed, within 10/15 seconds of my pressing the "send" button, the silly old bag will be on the phone bleating that "I didn't know that".
The problem is that, in the meantime, patient care standards are falling because one person doesn't know the whole of our jobs - and won't be told, which means that the new staff members are not being taught properly and actually resent being told what they should be doing, because they were not properly trained to start with.