Monday, 11 June 2007


This evening the computers weren't working. I won't go into the reasons because they don't matter. The only relevant fact is that despite our best efforts the computer system was completely unavailable throughout the evening surgery. This meant that I had no access to the details of recent consultations, or the patients' medication, or their Read coded problem list, or the prompts that remind me that information needs to be collected.

It was great!

I just sat there and looked at the patients and talked with them and used my expertise and knowledge and explored issues and explained things and felt on top of my game. If I wanted to know things that I would previously have looked up on the computer, I asked the patient. I had to write my prescriptions by hand, but then I didn't have to wait for them to print out.

Computers increase stress for the doctor and significantly impede thought and communication. I am not convinced that their benefits outweigh their disadvantages.
Where is the wisdom we have lost in knowledge?
Where is the knowledge we have lost in information?


Anonymous said...

Ivan Illich would be pleased to see you coming round to his way of thinking.

Nice to know you are not wholly convinced by the universal benefits of IT on every hard surface and can still occasionally talk to people. Is there no end to your attributes?

Dr Andrew Brown said...

Heh heh! Thanks, Anonymous.

In answer to your question: in theory yes, in practice the limit has not yet been reached.

Just kidding! :-)

Anonymous said...

Quick! Another questionnaire. It would be interesting to know is whether patients felt differently about the consultation according to how it was conducted.

I do not like that part where the doctor stares at the screen and appears to be ignoring me. Logically, this is a wrong interpretation. All the doctor is doing is reading the important data. But it FEELS like being ignored.

I reckon there is a research paper waiting to be written, based on comparing the responses of samples of patients allocated one consultation style or the other.

The Shrink said...

I do not like that part where the doctor stares at the screen and appears to be ignoring me.


I don't even have a computer switched on in the same room as I'm seeing patients and relatives.
Means I need to get my act together and have blood results, scan results and what have you printed off before hand, but being obsessive (a healthy trait oh so many medics possess) I print out all details and read through my patients' notes before clinics anyway.

Time in clinic is shared time with them, not time for me to sort my admin getting information/write my notes/collate information. I like the whole talking to the patient bit. To do it without distraction, as Dr Brown eloquently describes, is a liberating and healthy way to work that does seem to be appreciated.

Now if only there was latitude to eschew the 'puters all the time ;-)

Anonymous said...

But did you write yourself copious notes to be entered into the computer system when it was up and running again?

You see I'd believe you were more comitted to the Luddite Tendency if you been defiant and hadn't...but I bet you did!

Anonymous said...

Putting up pictures is good. Pictures are important. Even pictures with Bad News are better than none.

Our dentist has lashed out on screen technology which hovers above the chair so that both he and the patient can see the notes, which are not that interesting, but more importantly it displays magic pictures of the teeth.

Obviously, I cannot interpret the images, as that is what a dentist trains to do for years. But the effect of seeing the picture is profoundly reassuring and reflective; 'Them's my teef them are.'

I don't know why this works as a positive psychological benefit but I suspect it has something to do with a separate truth which Berkeley formulated for quite different puposes. 'To be is to be perceived'.

Yep, if I can see my teeth and you can see my teeth then I definitely exist, which is comforting for the moment. It also proves that there is some Medicine going on.

It is curious the disproportionate effect of certain actions. For example, 'Examining The Fingernails and Turning Over The Hands to Read Both The Palms and The Backs' ie exceptionally strong magic.

This is regardless of whether it is done by someone who knows what they are looking for or some fortune teller at a fair. I cannot explain why, I can only say that it is so.

Here is another thing. Towels are magic. Even disposable paper towels are magic. Any beautician will tell you, except for which ever bit you are working on, the rest gets covered with a towel. This is because cellulite, scars and body hair like a gorilla do not exist for the duration of being covered by the towel. This is also follows from Bishop Berkeley because the towel temporarily creates a no-perception field.

Of course there are limits to this as you can't cover someone up like they are a mystery lot at an auction if you are trying to work out if their entire spine is curving, but a towel is a much underrated examination aid, as is Shining A Torch.

Torches are only one down from Magic Wands and Lasers. People who vaguely wave them from the other side of the room are wasting the perceptual effect, diluting it to nothing. Have a good shine along a vein, over a joint, or do that thing they always used to do with examining the eyelid and the perceptual effect is called in.

Of course, this is all about perceptual effect in the patient's mind. It does not change the medicine, but it might change the attitude to the medicine.

A little torch some paper towels seem modestly priced tools compared to the fainting billions which is going to be spent on advanced crystal ball technology.

Dr Andrew Brown said...

It's interesting that such a short post is generating so many comments. I must remember to be briefer in future!

Anonymous 1: there has been some research along the lines you suggest, but I'm not academic enough to remember the exact results. I'll try to find out.

Cogidubnus: as you know, we have to keep a record of all our clinical encounters. That record is now kept electronically rather than on paper so, yes, I did enter notes into the computer later. We are now committed to using the computer, for better or worse.

I like the Shrink's modus operandi of reading all the notes prior to his clinical session, but we don't have the luxury of enough time to do that in general practice. As he keeps reminding us!

Anonymous 2: your comments about Magical Gestures fascinated both Martha and myself. Interesting stuff!

Anonymous said...

Do you find that using the computer hinders you in remembering patients from visit to visit? In other words, with notes et al on the computer, not as much is stored in your head, so you become more dependent on the technology?

Ms-Ellisa said...

Your post dr Brown made me smile :-)
Sometimes when a system breaks (whether it's a computer or the electricity) if you can manage without it with not much difficulty, everything seems to be more REAL...
Isn't that why romance is supposed to have half-lit candlelight places?
And by no means am I suggesting that being a doctor in the dark is romantic... :-)
Just the real part applies to doctors.

Dr Andrew Brown said...

Janeway: you make an interesting point. I'm not sure. I certainly find it harder to remember things about my patients, which I had assumed was due to getting older. It might be that when writing up my notes on the computer I am so concerned with recording everything accurately under the correct problem heading that it doesn't sink into my personal memory at the same time.

Ms-Ellisa: yes, not being able to hide "behind" the computer forces us to confront the patient. The encounter will be more "real" as a result.

Gruff said...

Ms-ellisa: everything seems to be more REAL...

Yes, I've lived in places with erratic or no electricity and I feel a lot calmer, more grounded