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CAMHS won't see you now

Woe betide those who dump their IT provider

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As a GP, you can face many tribulations over the course of your career: a particularly tricky diagnostic conundrum, a vexatious complaint, the gradually dawning realisation that everything about the job you once found joyful and exhilarating has turned to ashes and you are left effectively wasting your precious remaining years on something which actively makes you unwell; the list goes on. All of these pale into insignificance, however, when compared with the ordeal my partners and I have wilfully foisted upon ourselves this week. We’ve succumbed to federation pressure and changed our electronic patient record provider.

You’re reduced to hunting and pecking like your nan trying to send a text

Never do this. NEVER. DO. THIS. It’s the GP equivalent of a midlife-crisis-induced messy divorce; unceremoniously jettisoning a faithful yet frustrating old stalwart for a mysteriously alluring temptress, only to discover that that the temperamental new flame is in many ways worse than the vengeful ex. Then you find out the two of them have colluded to spitefully miscode all your drug dosages, which you now have to re-input tediously by hand, only you suddenly find yourself robbed of all the keyboard shortcuts which you’ve spent painstaking years building into your muscle memory like some kind of FP10 Mr Miyagi, so you’re reduced to hunting and pecking like your nan trying to send a text.

Basically this week sucks.

We’re lucky, at least, in our choice of EPR, as the coding on a rival’s QRisk2 tool turns out to be ropier than John Whittingdale’s Amazon Wish List. As a result thousands of people may potentially have had their cardiovascular risk over-or-possibly-under-estimated, although mercifully it appears no QOF points have been affected.

I don’t want to seem flippant about this, but, aside from the fact that Qrisk2 is about as accurate as an Imperial Stormtrooper with asterixis, which is actually worse? Being given NICE-unsanctioned advice because of a computer bug, or because you happened to see another GP with a different position on the Wald-Kendrick Statin Affinity spectrum, or simply because you attended a year earlier, before the cut off for cholesterol treatment was halved from one entirely arbitrary industry-approved target to another one? It’s the GPs who’ll have to spend hours working through lists of patients to sort out the mess I feel sorry for. At least the lucky bastards will have keyboard shortcuts.

Dr Pete Deveson is a GP in Surrey. You can follow him on Twitter @PeteDeveson

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Readers' comments (7)

  • I would be interested to hear from colleagues how many of them find a computer in the consultation room a useful adjunct to a consultation and how many feel it is an intrusion which gets in the way of an empathetic dialogue with the patient and reduces productivity.

    I ask because, being somewhat ancient, I recall happier times before computers when we could give the patient our full attention. I was particularly aware of this as I was a GP Trainee at the time and I and my fellow trainees were videotaping our consultations. I recall our regional trainer's video of himself when he had newly acquired a computer. His consultation time rose to 15 minutes and his eye contact time with the patient dropped to three minutes. I suspect. from my own visits to the GP, that matters have not improved.

    I also note that consultation times have escalated from 7 to 14 minutes.

    We are also distracted by the instructions given to us by this equipment which now tells us what to do in the consultation. So, the patient with the cancerous looking mole or suspicious lump discovers that we are intensely interested in his Blood Pressure and Cholesterol Level!

    Any ideas how we drifted into this mess?

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  • Totally agree with above comment. I too started work in general practice when it was all paper notes. Not only did we spend more time looking at the patient and listening to them rather than an annoying computer screen, it was also vastly quicker flicking through paper notes/ results than the equivalent on a computer.
    It was also much faster to write notes using little diagrams to express what it now takes a dozen words to say.

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  • GPs are the foot soldiers of the NHS and their function at any time is decided by the officers (NHS Manager) and Generals(Politicians).

    Computers are the perfect tool with which to control GP's actions including directing their consultation.

    The purpose of a consultation is no longer linked to the reason the patient has asked for it in the first place. The patient is first examined to complete the QOF tasks, and then - and only then - can the patient talk about his complaint. By then of course the 10 minutes are up.

    Doctors/Nurses have no choice - they have to perform as dictated by their computers. Patients have even less choice.Money is the master.Negotiators have landed GPs in this situation and at the moment there is no way out.

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  • Totally agree.
    Computers in general practice are not about making things better for patients,they are for the powers that be to monitor/control/regulate and assess what we are doing and for private providers to work out which bits of the NHS will give most profit for least work and hence worth taking over.

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  • sorry to disagree but I would be lost without the failsafe memory of my computer reminding me of allergies, and plucking results and letters from many years ago. Do you not remember trying to make sense of a thick bundle of lloyd george notes? then trying to get them back into the always too small envelope. Bad old days !

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  • Had a computer on my desk from mid-eighties; then a novelty, and handy for ICD code recording and repeat prescriptions. But I could never type fast enough to keep clinical records, and it was still the same at the last surgery I did five years ago.
    Now I'm a patient, and find myself irritated that the computer is the centre of interest, not me. It's certainly quicker to scan through the handwritten notes than the computer script in a small box on the screen.
    Too many administrators/statisticians/computer enthusiasts have defined the programming, and each has added their own pet 'wants' to the list of required records.
    I suggest that what is needed is high quality voice recognition to allow fast entry of narrative, and all the QOF and routine stuff being printed off for the patient as they arrive at reception. Thus the GP doesn't work as a poor quality clerk, and the patient speaks to the GP about their current concern only. But it will never work, because everyone is too busy typing in data to change the system.
    Glad I'm retired, just wish I didn't have any health problems needing medical attention!

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  • I agree with both above doctors.Computer is tool which can be very useful if it was owned by the tool user but instead negotiators in their wisdom passed the control on to NHS.With the current technology it possible develop a computer app which will filter all the patient data at a stoke and you will be free from the tyranny
    of computer for doctor and patient.

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