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The other day, as I watched my GP checking my history of back pain on her screen, I started ruminating on how differently GPs and hospital doctors use computers in their surgeries.
The classic hospital model I find at Hospital H, the general hospital, which handles most of my more mundane ailments. There, the endocrinologist sits behind a desk and leafs through my paper notes, while a PC sits in a corner displaying the Windows (Vista) logo.
The absence of computer does not affect the quality of the consultation, as the consultant is experienced and empathetic – and has a delightful habit of regaling me with all the shortcomings of the hospital's IT department and the National Programme for IT in general. He writes up my notes after I have gone, I suspect in longhand.
But my friend Bill, whose tardy diagnosis for prostate cancer I chronicled last November ('Taking care of the Bill'), experienced the defects of this classic model two weeks ago. He had undergone two months of hormone therapy to de-bulk the cancer and six weeks of radiotherapy to zap it. So he came to his outpatients' appointment, which would tell him whether the treatment had worked, with some trepidation.
The registrar – when Bill had been expecting a consultant for such a life or death pronouncement – kept her head down reading from the paper notes. The news was good, Bill's PSA had dropped from 19 to 0.3. The treatment had been effective.
But the doctor made no eye contact. Bill had hoped that she might at least join in his elation. But all that mattered to her were the figures on a page. Any eye contact was avoided: it was like a return to the 1950s. And yet, this hospital, in a university city, is one of the most prestigious cancer hospitals in the UK. Bill's story confirms my view, expressed often in these columns, that the more famous the hospital, the more deficient it is in elementary skills.
The surgeries in 'Fastrack', the specialist hospital which has been treating me for a life threatening condition for the last 18 months, take a different approach. The consulting rooms have no desk for the doctor to hide behind and no computer – just a bed. The consultation is an unmediated dialogue between doctor and patient. All the notes, records and computers are next door in a sort of common room for the clinical team.
So the doctors have to bone up on my history and memorise it before they enter the consulting room to see me. And after the consultation, they go back next door to write me a prescription and a booking for the next appointment. I have to hang around in a waiting area for a nurse to bring me these. The computer is invisible. But I don't mind, because I have had 100% of the doctor's attention. This is much better than the classic hospital model, where the patient often sees only the top of the doctor's head.
My GP's surgery is again quite different. The computer is centre-stage, and there is no paper around at all. Much of the consultation is a conversation between me, the GP and my patient record. And at the end the GP prints prescriptions, radiology and pathology requests, and my notes, while I dress after the examination. All done, dusted and electronic.
Of course, GPs have been using computers much longer than hospital doctors, since the early 1980s. Then, GP systems were written by doctors to be as doctor-friendly as possible. Hospital systems tend to have been written by IT people, and are often operated by clerks rather than by doctors. In a GP surgery, there are no clerks or IT departments. The systems have to be easy to use. There can be no slack in the system. I doubt whether hospital doctors will ever catch up.
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