Yes / No

training for primary care staff computer

Late night on Twitter is bandit country.  Fuelled by Bacchus a lot gets said.  Best avoided.

However, ignoring my own advice; a couple of evenings ago, I watched some very interesting exchanges between Gordon Caldwell, a consultant physician working in Worthing and various insomniacs.

Have a scroll through his time-line.  Look for a picture of two computer screens and start ferreting from there.

Gordon Caldwell was bemoaning his lot and I understand why.  His complaint is not that he is bogged down by a Luddite Trust that makes him work all his problems out with a pencil.  It is quite the opposite.  Caldwell complains, in terms, he has too much technology.

He has systems, software and a screen full of stuff that is making his life a box ticking misery.

Other somnambulists joined Caldwell’s Twitter beef.  Interesting insights into doctors talking about the modern tools of their trade.

The difficulties of recording information on a screen and at the same time, engaging with the patient.  Looking them in the eye.  Seeing the whole person over the top of the computer.  

You want a digital NHS; you’ve got it and it looks like it’s rubbish.

For people who live ordinary lives, outside the magic circle of computing, tend to revere developers and are in awe of anyone who can understand the innards of a computer.  

Most of us use a computer but few of us understand how they work.  We don’t have to.  All you have to know is you press start to make it start and start to make it stop… 

I can tell you, it is a conspiracy.  Computers are basically stupid.  They work in binary.  That means they only understand yes and no.  Black and white.  That is why they are so old fashioned.  Mutton dressed as lamb.

Get up in the morning and think; ‘I’ll wear a red shirt’.  Involve a computer and you have to answer: 

do I want to wear anything, yes/no; 

is it a jumper, yes/no; 

it is a T-shirt, yes/no; 

is it a shirt, yes/no; 

long sleeves yes/no; 

short sleeves yes/no; 

white, yes/no

colour, yes/no; 

colour red, yes/no; 

is it blue, yes/no

… and so you end up, in a nice smart shirt but because of the palaver, you’ve missed the train.

You may be thinking artificial intelligence; ‘Allegra, get me a shirt…’

‘The same as yesterday, yes/no…’ and it all kicks off again.

You can see the Caldwell conundrum. 

Imagine dealing with a frail elderly patient admitted with a UTI and a fall and a background health of COPD, diabetes, blood pressure, ?sepsis and the whole nine-yards.  

Maybe cognitive impairment; fall or dementia?  Caldwell is left working half a dozen bits of software on two computer screens.

The management of information by the use of technology is a pain.

Junior doctors tell of turning up at the ‘next hospital’ in their training journey having to scrap the last five Apps they have been using and download the half dozen ‘this Trust’ uses.

GPs have developed the Cromer-technique; sitting sideways, like a crab, to give the patient some semblance of engagement and at the same time clicking boxes to earn their spondulics and more boxes to pay deference to clinical audit and diligence.

It’s too easy to write software.  

You and I can learn to develop an App after an hour poking around YouTube.

Open source, cut and paste, colourful interface; the production line of software development is avalanching an immature customer with stuff that probably does something, but taken together, is grinding the system to a halt.

Integration, whole system thinking, cleverer procurement, consulting the users, understanding the working environment, deciding what you really need to know, what you’d like to know and what you know already.

Listening to junior doctors would be a start.  They are the nomads of the NHS.  Peripatetic, they know what works and what doesn’t, they know what systems create time and what systems steal time.  They are the only part of the work force that can compare one system to another.

And in the language of developers; Is it a good idea to listen to the customer, yes/no…

Have a good weekend.


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