I had a doctor’s appointment this morning to organize some repeat prescriptions that I hadn’t been able to order online. It turned out the practice had a new computer system. Though many details had been ported across accurately, several pieces of information were missing or incorrect. In this case, I couldn’t order repeat prescriptions because the system showed the previous issue date as 30 January 2013. This, it transpired, was when my records had been ported in.
(I’ve been through this before. When my previous practice first computerized its records, much of the information held in the physical files wasn’t transferred. In my case, and my mother’s, this meant jettisoning the complete list of medication known to produce an allergic reaction. Since both my parents were allergy-prone, I started collecting allergies early in childhood; and over the years they have increased in number considerably. I was reasonably clear on the drugs that had demonstrated their hostility to me in adulthood, but not all those that had been noted on my medical records when I was a child. Having the information on the records was useful; it meant that doctors didn’t have to rely on my memory: they could see which drugs weren’t going to work for me, thereby saving me a greater or lesser amount of unpleasantness, and saving the NHS money. I’ve never understood why this transfer to the computerized system wasn’t announced in advance, so patients had the opportunity to obtain such crucial information before it was lost forever. If the drug-allergy information was important enough to write on my file in the first place, when and why did it stop mattering? A related question: why does no doctor or nurse ever read the ‘latex allergy’ warning written in huge red letters on the cover of my hospital records? They ask unexpected questions, and while I'm racking my brain for the response, they pull on the Wrong Colour Gloves, and then I'm in trouble for not telling them in time…)
Back to this morning. Because my current doctor’s system no longer showed that I had undergone an annual medication review in September, I had to have my blood pressure and weight taken, and then I had to answer the standard questions doctors are required to ask, seemingly at every consultation, on smoking (the system no longer registered that I gave up last year), drinking (somehow I still managed to be lectured, even though, in an attempt to lose weight, I had halved my intake to a maximum of four units a week), eating habits (somewhat curtailed: see drinking, above) and exercise (another lecture… If exercise gave me the endorphin hit everyone promises, keeping up the gym visits would be easier; sadly, it never does and never has. I’ve yet to find a doctor who can explain this to me).
Then the doctor started on the computerized prescription routine. As I watched her open each medication record individually, make changes to the date, and then hit OK, I couldn’t help thinking that, overall, the appointment hadn’t made best use of her highly-trained (and thus expensive) time. The vast majority of the appointment involved the doctor typing in blood pressure and weight figures, asking simple questions from onscreen prompts (‘Do you smoke?… When did you give up? … How many did you used to smoke per day? … How many units of alcohol per week?’ ‘Dunno, but I drink four glasses of wine’) and entering the answers, and inputting dates and other non-specialist data into the system.
No medical training is needed for this. It cannot be cost-efficient for fully qualified doctors to perform tasks that could be done by less highly trained, and cheaper, staff. Hospitals use a combination of nurses and administrators to gather and record preliminary information before the patient sees a doctor. Such functions could be carried out by nurses and administrators in general practice too, freeing up doctors’ time for tasks requiring their expertise. A practice with a do-it-yourself blood pressure machine could free up the nurses’ time for something more vital, too.
All this took at least 10 minutes. My surgery has several large notices stating that a patient should only raise one issue or problem per appointment. This isn’t rare: several people I know tell me their surgeries operate this rule, and some even impose a time limit. A quick trawl with a search engine shows that many surgeries’ websites operate a similar system. Twice, a doctor has politely remonstrated with me for bringing two — brief, and once, so I thought, related — problems in; so I know they are serious about it.*
(I’ve been through this before. When my previous practice first computerized its records, much of the information held in the physical files wasn’t transferred. In my case, and my mother’s, this meant jettisoning the complete list of medication known to produce an allergic reaction. Since both my parents were allergy-prone, I started collecting allergies early in childhood; and over the years they have increased in number considerably. I was reasonably clear on the drugs that had demonstrated their hostility to me in adulthood, but not all those that had been noted on my medical records when I was a child. Having the information on the records was useful; it meant that doctors didn’t have to rely on my memory: they could see which drugs weren’t going to work for me, thereby saving me a greater or lesser amount of unpleasantness, and saving the NHS money. I’ve never understood why this transfer to the computerized system wasn’t announced in advance, so patients had the opportunity to obtain such crucial information before it was lost forever. If the drug-allergy information was important enough to write on my file in the first place, when and why did it stop mattering? A related question: why does no doctor or nurse ever read the ‘latex allergy’ warning written in huge red letters on the cover of my hospital records? They ask unexpected questions, and while I'm racking my brain for the response, they pull on the Wrong Colour Gloves, and then I'm in trouble for not telling them in time…)
Back to this morning. Because my current doctor’s system no longer showed that I had undergone an annual medication review in September, I had to have my blood pressure and weight taken, and then I had to answer the standard questions doctors are required to ask, seemingly at every consultation, on smoking (the system no longer registered that I gave up last year), drinking (somehow I still managed to be lectured, even though, in an attempt to lose weight, I had halved my intake to a maximum of four units a week), eating habits (somewhat curtailed: see drinking, above) and exercise (another lecture… If exercise gave me the endorphin hit everyone promises, keeping up the gym visits would be easier; sadly, it never does and never has. I’ve yet to find a doctor who can explain this to me).
Then the doctor started on the computerized prescription routine. As I watched her open each medication record individually, make changes to the date, and then hit OK, I couldn’t help thinking that, overall, the appointment hadn’t made best use of her highly-trained (and thus expensive) time. The vast majority of the appointment involved the doctor typing in blood pressure and weight figures, asking simple questions from onscreen prompts (‘Do you smoke?… When did you give up? … How many did you used to smoke per day? … How many units of alcohol per week?’ ‘Dunno, but I drink four glasses of wine’) and entering the answers, and inputting dates and other non-specialist data into the system.
No medical training is needed for this. It cannot be cost-efficient for fully qualified doctors to perform tasks that could be done by less highly trained, and cheaper, staff. Hospitals use a combination of nurses and administrators to gather and record preliminary information before the patient sees a doctor. Such functions could be carried out by nurses and administrators in general practice too, freeing up doctors’ time for tasks requiring their expertise. A practice with a do-it-yourself blood pressure machine could free up the nurses’ time for something more vital, too.
All this took at least 10 minutes. My surgery has several large notices stating that a patient should only raise one issue or problem per appointment. This isn’t rare: several people I know tell me their surgeries operate this rule, and some even impose a time limit. A quick trawl with a search engine shows that many surgeries’ websites operate a similar system. Twice, a doctor has politely remonstrated with me for bringing two — brief, and once, so I thought, related — problems in; so I know they are serious about it.*
I was, therefore, more than a little puzzled by what happened next. My doctor finished updating the records and clicked the onscreen button to send the prescriptions to the printer. At this point, a large pop-up box appeared on the screen. The doctor told me that it was a reminder saying, in effect: ask the patient if there’s anything else you can help with — thus completely conflicting with the well-publicized and apparently strict only-one-problem-per-appointment rule.
I'm not sure this new system has been well thought through…
* In November 2011, the NHS reported that doctors in general practice spend an average of 8–10 minutes with each patient; two months earlier, Dr Roger Henderson had suggested that the average is 7 minutes. A new survey is due later this year.
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