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Self-management benefits in diabextes and BP control

My patients love my computer.

And I can see why; after our last upgrade, it looks like something out of Star Trek. It is sleek, has a flat screen, and has various devices sticking out of it. The keyboard is black and aerodynamic, with curved edges. There are loads of extra keys. I have no idea what any of them do but they look very 21st century.

When I have an idle moment

I try them. One is marked ‘Pause'. When I press it, nothing happens. So does it actually work? I think it probably does. Another says ‘Sleep'. When I press that I don't feel even slightly drowsy, so I suspect one is broken. Still, there are plenty more.

Patients seem to feel they are in good hands if slimline, expensive-looking hardware is controlling their health care. As a child watching Star Trek, I always wanted Dr McCoy's tricorder. Admittedly, when Bones waved his tricorder over a supine red-shirted security guard, he usually looked grim and said ‘He's dead, Jim', but I'm sure

I could come up with something more positive.

One of my more computer-literate patients was quite excited by my latest model, and asked if it was voice activated. ‘Watch this,'

I said. ‘Computer! Gimme a summary of this patient's recent medication!' I surreptitiously hit the ‘repeat prescription' button and the computer sprayed out the required information. My patient left shaking his head in admiration, and I could tell he was already cured.

To be honest, in our practice we regard the computer system as a neat way of doing repeat prescriptions, and if we have anything important to record, we use a pen and paper. But if our patients have faith in technology, it seems a shame to disabuse them.

Recently, I was sharing a nursing home lift with a technologically minded colleague. Nursing home lifts are one of the more important social tools in general practice; they are powered by two AA batteries and you can spend anything up to 20 minutes making small talk to strangers. ‘What's that thing you've got there?' I asked him. ‘Palmtop,' he replied. ‘I've got all the practice records on it. Wonderful piece of kit.'I was impressed, and I thought my patients would be too if I had a hand-held computer. So I borrowed my son's Gameboy. I would do the visit, then spent five minutes with furrowed brow, playing Thunderbirds with the sound off while the patient watched breathlessly. I would guide Thunderbird Two through the helium-filled floating mines, save the game, and nod sagely. ‘That's that!' I would tell them, to an audible sigh of relief.

Yesterday it went wrong. I visited a teenage lad with abdominal pain, decided there was nothing much the matter, and spent a relaxing 10 minutes destroying international terrorists. My patient kept trying to see the screen. ‘Sorry, can't show you,' I told him. ‘Medical confidentiality.' ‘That's not a palmtop!' he exclaimed. ‘That's a Gameboy Advance! I can see the cartridge sticking out of the back!'‘I thought you were supposed to be ill!' I retorted. ‘Do you want me to send you to hospital for an operation or what?' I tucked my hand-held computer into my briefcase and left, head held high.

peverley@supanet.com

Phil Peverley is a GP in Sunderland

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