Photographic evidence. A long, convoluted road.

I have been on a mission.

I want to have some of my patient’s pictures attached to the electronic patient record.

More specifically, my aspiration is, for the care home residents I support (between 60 and 90 people), I would like their photo on their record, so, when I am writing about them, reviewing blood and test results or perhaps talking with a family member, I have a better idea who they are.

Much of this relates to the limitations of my brain.

Some have no problem attaching names to faces, others, like me, struggle. In general, I fail with names. Usually, if I develop a relationship with someone, nothing salacious, more, professional or even personal, their name will stick, I might have to ask how their name is pronounced or what they would like to be called, but eventually I can attach some facts about them to their name and their face. My brain does the rest.

For some of my care home residents I struggle.

It is hard for me to link a name to a face if I have never had a conversation (beyond, ‘Hello, it’s the doctor, how are you today?’ tropes). I might have talked with their husband or wife, but that is not the same, and even harder if that conversation had been on the phone.

It is a sad reality of dementia in particular that for some, by the time the disease is advanced, much of the personality is not gone, but locked away inside, as is the ability to engage in generative conversation.

For me, also, when I have the name and the face, usually, I will remember all their clinical history, their medicines and even recent and pending blood results. I have a system, it is unfortunately not very flexible.

And thus the pictures.

It is an oddity, yet, patients who have been sectioned under the mental health act and inpatients in our local psychiatric ward have, as a default, their picture attached to their file. I am not sure of the reasons for this. Perhaps it’s in case they run off, or maybe if a new nurse is administering medicine and the patient is unable to reel-off their name and date of birth, it helps.

In the care home there are a few people who have been sectioned. They all have photos.

In the surgery we have one or two other patients who have guns. If you have a gun license in the UK it seems you have to have your picture available on the medical record. I suppose that is to avoid the wrong people getting hold of firearms.

And so, I had the idea to get photos of my old folk in the care home, to help me, essentially to facilitate my making their care better.

I am sure the casual reader will be thinking, ‘What’s the problem?’

They probably haven’t ever met an information governance officer or the complexities of GDPR (General Data Protection Regulation).

The two combine to stifle innovation and creativity. They are a block to doing anything out of the ordinary.

This regulation was enacted in the UK a couple of years ago to prevent the misuse or abuse of electronic or personal data, as a vehicle to hold organisations and in particular the big tech firms to account in the event of data being sold, moved or misappropriated.

All this is good as we are collectively vulnerable to digitisation and the toing and froing of our personal information, particularly in an age of techno-fraud, big data and all the rest.

Yet, if you are me and you want to do something a little different, you are back with David Walliams and, ‘The computer says no.’

Information governance people are prophets of doom and negativity. It appears their duty to think of everything that might go wrong, blow it out of proportion and stifle new ways of working.

And, that’s where I am.

I have been trying to do this for months.

No luck.

I won’t give up.

It is a battle of wills and persistence.

I can be persistent.

You might call me tenacious.

Not sure where I inherited this characteristic.

Sometimes it works, at others it leaves me unfulfilled.

Yesterday I visited a very old woman who has learning disabilities and lives in a ‘group home’ that is, with two other women and two full-time carers.

The carer showed me the patient’s foot.

‘Doctor, could you at the rash? What do you think? The steroids don’t seem to have helped.’

I had popped-in to administer a Covid booster, so I didn’t have access to the patient’s clinical record (another person I have met several times but can’t link her name to her face).

‘Why don’t you see what happens over the weekend and if it is no better on Monday, call the surgery, you can send a photo.’

‘Oh, we couldn’t do that, we aren’t allowed to take photos.’

‘I guess you could describe it.’

I understand the restrictions on taking pictures on personal or work phones of rashes – they could be abused.

The alternative? Try another cream? Get a doctor out to look at the very old woman’s foot? Take her to the surgery?

It seems that we have so many technological gifts, yet we are still in the primacy of how to use them.

We, that is, society hasn’t come to terms with the power of social media, or artificial intelligence.

We, the primitives don’t get the transformation that can be achieved through its use, we thumbs-up soundbites and ‘like’ pictures of puppies and kittens.

We have a lot to learn.

There is a lot to do.

Have a good week.