In Douglas Adams’ classic, the Hitchhiker’s Guide to The Galaxy, he introduces the idea that when a creature is dying it sends out a distress signal that connects it to its place of birth. Against all expectations I recently felt a similar moment of serenity and oneness with, of all people, an anonymous member of the EMIS coding team.
I don’t know what proportion of you will use the latest version of EMIS, but it’s a chirpy little system, constantly looking for ways to please. As the day wears on and your typing becomes more haphazard, it pipes up with friendly little suggestions of what you might mean. Mistyped ‘to go’ as one word? Not a problem! Presumably you thought it important to record that your patient was born in Togo, or perhaps had once visited there. And fear not if you did, because both scenarios are covered by their own pre-set text, and a code in case you have a future urge to audit just how many of your patients started life by the Gulf of Guinea.
So there I was, one evening, finally typing up the notes of an emergency home visit I’d done that morning. Despite what the media will tell you, a GP will still break off hiring his second butler to visit a patient with a nasty-sounding COPD exacerbation. And as I tried to cudgel out of my brain exactly what had happened on the visit, something wonderful happened. I’d definitely given a neb, and it had definitely improved matters. And so I tried to type ‘good response to neb’ – but got no further than the first word.
This was because I had naturally fallen at the first hurdle, and mistyped the first word. And EMIS, like a puppy that’s still happy to play chase with you even though the Frisbee has landed in a hedge three feet away and the rest of the park are pointing and laughing, was eager to help. My mistyped ‘good’ had generated the suggestion of diagnostic code R2yz-1, or ‘God only knows’. I am absolutely serious. I invite you not only to check this one, but to let me know any similar ones you find. Because although we’ll have to be careful about using it, in the light of Dr Richard Scott’s experience, isn’t it comforting to know that there’s at least one clinical code boffin out there who knows what it can really be like at the coalface, and that not everything can be made to fit in a box?
Dr Nick Ramscar is a GP in Bracknell, Berkshire