Yesterday I received a letter from a GP.
How many of you (patients, that is), realise that within our health and care system, on which at times your life, or the life of your family depends, and, despite 21st century technology that can take us to Mars and back, doctors are writing each other letters.
Sometimes these correspondences aren’t even word-processed; hand-written, some folk use fountain-pens. Technology that predates Gutenberg.
It isn’t even that straightforward –
When I see a patient in my clinic, I dictate the letter to an electronic system that is then typed by my secretary (a person) (on Word), then printed, and posted (2nd class – NHS austerity and all that), and delivered (Royal Mail) to the GP practice where the letter is scanned (by hand) onto their computer system before being read by the GP (on their PC).
Amazing, isn’t it?
And, faxes – don’t even get me started!
Why are seemingly intelligent people, working in complex systems, content with this medieval communication? I guess, in many instances, that is just the way it is. It is the way we have created our systems of governance and information security.
A letter is perceived to be more secure than an email, which, anyone with a sophisticated de-encryption programme could access. Yes, Lithuanian hackers are interested in the state of my eczema, varicose veins, or, schizophrenia.
And email – another hazardous conundrum.
What to do when a patient contacts me by Gmail?
The guidebook will advise that I cannot know that Jim_Morrison@outlook.com is from Mr Morrison, and can’t be trusted. I should either ignore the incoming or reply politely with, ‘I know you sound like Jim, heck, your rendition of ‘The End’ is authentic, but, unless you are NHS.net, you could be anybody.’
I sometimes hear similar conversations on the phones at work,
‘Sorry Mrs Brown, I can’t tell you any confidential information about your son,’
‘I just want to know how he slept’
‘Sorry, that is personal information… Do you have the code-word?’
Yes – back to medieval times… knock three times, give the code-word and you will gain access to the walled city. I keep thinking of Münster – check it out if you don’t know the story.
And, there is good reason for all this unsophisticated limitation, we don’t want private information shared; what is private should be between the doctor and the patient, yet, we are prepared as a society to spend ten billion pounds (that was the estimated cost of the failed national programme for IT), and, pretend that falling-to-pieces curtains possess a unique form of sound-proofing that the patient in the next bed cannot perceive.
‘Please breath-in and push down, like you are doing the toilet, Mrs M.’
‘No, not enough, harder… Again!’
‘Oh doctor’ and so on…
It is silly, really.
And, here, I think of Douglas Adams and the Shoe Event Horizon on Frogstar World B that collapsed because it was overwhelmed by shoe shops. Mindless competition and focus. Missing the big picture.
I could write to my colleague, I could try to penetrate their surgery’s phone system – heck, there are even a couple of local GPs whose numbers I have in my contacts, but most not.
I will likely wait four or five days for the (tattered, paper) notes to arrive in my office, read through the admission, dictate, type, print, scan and eventually they will have an answer to the question).
I know there are hospitals that have this sorted (in the UK) (The US and Australia by comparison are working in the light of day). Emails and texts fly backwards and forwards between patients, carers, doctors, nurses, therapists, social workers, psychiatrists and on and on. They use the speed of light to ensure our patients are sorted.
These places and systems are a tiny minority of all the health and social care organisations in our country.
Isn’t it absurd?
That is the NHS.
firstname.lastname@example.org – this is not a secure email; it can probably be hacked by my 93-year-old next door neighbour who doesn’t own a computer. There you go. Let me know what you think.