The cult of computationalism

Ever wondered what a 'referral pathway' actually looks like? Our surreal blog Through the K hole takes us deep inside the workings of the NHS

He sat, sequestered deep inside the bowels of the computer, his face washed with electric blue light.

He was a digital submariner, sweeping the oceanic depths. As he worked on a set of overhead fans sighed out the heat, cooling the crystalline web of electronics and buzzing fibre optics. Thick bunches of sinewy wire rolled about his feet. They were the guts, the very innards of the machine.

He was sitting patiently at his terminal as a pod pulsed down through one of the communication tubes. He removed it, popped open the cap and took out a piece of paper. It contained a set of abstract shapes. They looked like Chinese letters and resembled the fluid characters found in Mahjong. But the symbol didn't represent benevolence or sincerity or piety - in fact. it represented nothing for him. Despite the fact that this was all he ever did, down there hidden from the sun in the argon light, he had no inclination or compulsion to find out what it all meant. To him it was purely abstract geometry, nothing but symbolic, synographic white noise.

He walked over to a vast bank of rectangular drawers and found one which matched his symbol. He unhooked it with a long pole and took out a piece of paper which also had a different but equally meaningless character on it. He neatly folded it, put it back into one of the empty pods and loaded it into the machine. He fired it back up into world which he had never seen and had no conception of what he had just communicated, no idea at all of what it meant.

Far above, high in the distance, the GP received this electronic reply. It flashed into his inbox, a pod of information sent from the central computer. His urgent referral letter, which he had sent on behalf of his patient whom he had known for years, had been rejected.

Seemingly it had been checked electronically by an unthinking programme and had been squeezed out of the system by an emotionless algorithm. He threw his stethoscope into his bag and swore under his breath. The cult of computationalism, referral pathways and evidence-based medicine had once again been allowed to override the humanity of medicine.

Written in response to the Notes From The Dark Side blog on GP referrals 'Pain but no gain?. Dr Kevin Hinkley is a GP in Aberdeen.