Confessions of a GP

11. For snakebites: bleed the wound and rape the victim in a blanket for shock.

12. For asphyxiation: apply artificial respiration until the patient is dead.

13. Before giving a blood transfusion, find out if the blood is affirmative or negative.

14. If the lady is sexually activated, you must do a pregnancy test.

Computers

I was on holiday in Namibia. I was sitting around a fire in one of the most remote deserts on earth, yet simply by using my mobile phone, I could instantly view photos of my cousin’s new boyfriend in Australia and read a full and detailed report on how my Sunday league football team had lost again in my absence. Once back home in NHS land if my patient goes to see a consultant at the hospital two miles down the road, I have to wait several weeks for his letter to be typed, posted, arrive at my surgery and then be filed by my secretary. It seems crazy to me that we are so backwards when it comes to something as essential as sharing important information about patients.

In general practice our failure to have embraced technology is usually nothing more than an annoyance, but in hospitals it can be more than that. Currently, if an unconscious patient is admitted to A&E in the middle of the night, the doctors will often have very limited medical information about them. The patient might have some paper notes in a file sitting in a secretary’s office somewhere, but unfortunately, there is no way that the A&E doctor can access the GP’s computer records, which might have lots of very useful information that could potentially help save the patient’s life.

If A&E had access to the medical records, we might have information that s/he was a diabetic or a heroin addict or even that s/he had advanced cancer and didn’t want to be resuscitated. As you can imagine at 3 a.m. on a Sunday, this information could be very useful and greatly increase the speed with which we could make a diagnosis. The records might also give us a relative’s telephone number and a list of the person’s normal medication.

There are obviously big benefits of having all our medical records on a computer system to which all healthcare professionals can have access. The area that many people are concerned about is maintaining confidentiality. There are so many people working for the NHS and in social care that sensitive personal information about us all could be available to a huge number of people. For example, if my sister up in Newcastle started seeing a new bloke, might it be tempting for me to look up his healthcare records? Unethical as it would be, I could find out if he had ever had genital warts or been arrested for hitting his ex-wife. These are the sorts of personal details that are often on our medical records and access is currently only available to the staff at your current practice.

Presently, the government is investing billions into a new integrated computer system for the NHS. The plan is that we will be able to store patients’ records centrally and also send referral letters and book appointments online. We are nowhere near having the system fully in place yet, but there have already been the usual grumbles of discontent. This has partly been because of criticisms about the quality of the technology and also opposition from patients and doctors. Personally, I do think that we do need to update the way in which we work. The technology would be a huge time-saver and, in some cases, a life-saver. Somehow we need to maintain patients’ trust and perhaps do this by allowing them to keep certain parts of their records excluded from the national database. The worst possible outcome of a national computer system would be that patients no longer felt safe disclosing personal information to their doctors.

Kieran

Perhaps the most influential thing that happened to me at medical school was the death of a close friend. Kieran and I did our A levels together and as I went off to medical school, he had gone off to Leeds to start a psychology degree. Towards the end of my first year, I got a phone call from Kieran saying that he was in the hospital attached to my medical school. He had discovered a lump in his armpit some time ago, but full of the excitement of his first year at university, it had taken him a while to get round to seeing his GP. He was quickly diagnosed with a type of cancer called non-Hodgkin’s lymphoma.