Thanks Jane for allowing me to continue today’s blog; that was about the ways in which Covid has forced a change in my behaviour (likely, yours too) which in turn has led to changes in my brain.
It is along the lines of the blog I wrote ages ago after reading a Stephen King book – by reading my blog (or his book) you are able to read my mind, or, I am able to inhabit yours.
Jeepers; that takes me back to 1990’s & reading Alexander Trocchi – there is a blog somewhere about him and that topic; the link is here.
Jane, who prefers to use LinkedIn, commented on the Big Step Forwards in the use of technology to communicate and engage with colleagues, customers and patients or clients.
If you want an analogy, you could think Global Warming and Evolution; with the former, our existence is under threat as it is happening too fast for nature to adapt; with the latter, and the slow inching-forwards of change over millions of years, the ecosystem can respond.
We went from me sitting (don’t tell any infection control nurses) on a patient’s bed, perhaps talking about their experiences, where they live, and my favourite, if they are Scottish, where they come from, to help me gain an understanding of what is wrong, what matters to them, and so on, to, my sitting at home with a rickety monitor and mono speakers trying to engage with that same person through an outdated android phone held by a nurse gowned-up in visor and facemask.
Our patients (and staff) haven’t had time to adapt.
Neither have I.
I know when the pandemic was at its height there were many acts of kindness; you know the images of ITU staff holding the hands of patients as they slipped away – yet, for all that, because of the necessity for clinical and organisational expediency, that temple of Person-Centred Care at which I have worshiped for so many years was swept away.
Patients were moved around, the time of day or night less an issue, their families’ cut-off, discombobulated on a journey to an uncertain outcome.
Our compassion systems didn’t have time to adjust or adapt; within days we were banning visitors, consigning ‘End PJ Paralysis’ to the backroom and focusing on White Cell Counts.
That was a terrible time which for many is still too raw to discuss; for now, I will return to the consultation.
For the purposes of illustration I will provide you a sketch of the process;
9am I log-on to Microsoft Teams (the Zoom the NHS has chosen to use) and my colleague V. is waiting; she is a nurse practitioner who helps me do the doing. We say hello, quick update and we wait.
In the old world, I used to start my ward rounds (for that is what this is) at 8am and mostly I would be there, V would be there and whichever nurse was joining me would be there;
For whatever reason, e-rounds don’t trigger the same level of attendance and we are usually waiting for the care home nurse to log-on.
The next steps are a well-honed routine; V rings the care home, ‘We are waiting for X, is everything OK?’ ‘We have a ward round.’ ‘Oh, they are not working today, can you find someone else to help?’
15, 20 minutes pass.
V’s phone rings;
Can we use Zoom instead, they can’t log-on to Teams.
The video is switched on, the microphone eventually works and, we begin.
This might sound petty, yet, when you are busy, and have lots to do, these delays are painful.
We review the patients in an online discussion – logging on to computer programme A, B or C to obtain details of the patient’s GP, what happened in hospital, previous health problems, medicines, blood and x-ray results and so on.
Eventually we meet the patients.
X, takes his Android tablet to patient number one; let’s call her Stella.
Stella, (made-up patient), is 95, she has visual and hearing impairment; X is wearing gloves, a yellow apron, facemask and plastic visor. He greets Stella, ‘Look, here is the doctor, and that is V the nurse practitioner…’
I am thinking, ‘What is Stella thinking?’
More often than not, I start my spiel, ‘Hello Stella, my name is… how are you today?’
I’d say on 80 per cent of occasions Stella who might have dementia and has just recovered from a broken hip or Covid or both can’t understand; X translates my words, ‘The doctor is asking how you are feeling…’
The screen freezes; I can’t hear the answer.
Are you getting the picture?
It causes me an actual physical pain, such is my level of frustration.
And then, we move on to the next patient, and the next.
Yes, this is the post-Covid clinical encounter with an older person in a care home.
I have to confess, before Covid, the clinical reviews older people experienced both in and out of hospital were not equivalent to those of us who are younger; broken hearing aids, lack of privacy, visual impairment, co-morbidities, dementia, delirium all contributed to a muffling of experience; and now we have tech in the way.
What is the answer?
We can’t go back.
Many of us don’t want to go back.
Teleconsultation has led to so many increases in efficiency that a return to filled waiting rooms with patients coughing and sneezing on one another will surely become impossible.
Yet, how do we help the systems evolve?
If I were a radiologist; you know, those guys who hang around in dark rooms looking at x-rays, and I were viewing the images on a computer, there is a standard resolution, number of pixels and lighting conditions which must be met before I can proceed; without this standard the risk of misinterpretation is too high.
Yet, with my slapstick reviews there is no consideration of standardisation.
I bought myself a PC monitor at the beginning of Covid as the little laptop screen was already giving me headaches; I also bought a separate camera which isn’t very good, although I am reluctant to replace it as the cost of these devices rocketed with Lockdown (like thermometers and facemasks).
Yet, there is no standard for the nurse in the care home; they can have the most up to date hardware (I suggest an iPad) and fast internet; colleagues may or may not have the same. We might succeed in using Teams, or we might fall back on other software. People will freeze, lines will drop.
If you are unlucky enough to be a care home resident and only cheap internet is installed the consultations will be poor; if you are extra-unfortunate, you might be in a room where the Wi-Fi or 4G doesn’t stretch.
Good luck getting on with that.
I have not answered my question yet; here I go.
We need to have minimum standards for hardware, software and internet connectivity.
Not that difficult.
It is unacceptable for a patient to peer into a dodgy Android phone over a weak broadband connection when I am asking them sensitive questions; mistakes can be made, it is inequitable.
Once we have these standards, there has to be a minimum level of training provided to those staff in the use of this tech.
This might seem a harsh, yet, what I see is the government scrambling to make good of the mess they created with Covid, with the inadequate supplies and poor lines of communication, the dodgy guidance and decade-long asset stripping of health and social care.
Let’s get this right and we might be able to start to understand how to navigate the new world.
PS Apologies for any errors in this blog; WordPress have changed the interface and I haven’t worked out how to use it yet; ironic, I know.