The Dragon Didn't Have Teeth After All

Over the last week I have written here and here about giving a demonstration of the patient-access system that my GPs' surgery uses as part of a presentation given by B, who was my GP until his recent retirement. The presentation and demonstration was to be given to an audience of doctors at a medical education establishment in London and I was very nervous about it.

Delivering presentations and demonstrating computer systems were things that I used to do without turning a hair some years ago. However, my worsening depression and acute anxiety meant that I found these things impossible and facing an audience of unknown people filled me with horror. Since having to give up work I have not been required to do such things, and a few months ago I would not have contemplated doing it, but when B asked me to carry out the demonstration because he felt it would add impact to the presentation if done by a patient, I agreed without hesitation. I was still very nervous at the thought, but I have done quite a few things just recently that I would not have considered possible six months ago, so I was willing to give it a try.

The establishment was imposing and I couldn't help but feel nervous as I entered through its doors on Wednesday afternoon and awaited B's arrival so that we could check out the lecture theatre and its audio-visual facilities and discuss how we would approach the presentation. We encountered problems immediately because we found that I could not get logged into the system that I was supposed to be demonstrating.  This did not bode well for me.  However, B had a few screen shots of from the records of a fictitious patient so I went through these to familiarise myself with what they showed and accepted that if necessary I would use those; it wouldn't have the same impact as doing the demonstration for real with a live record, but it was better than nothing.  We chatted for a short while, then tried logging into the database again, and everything worked perfectly, so I ran through what I intended to show and say to B and he proclaimed himself more than satisfied.

At this point we had done all the preparation that we could so we left the lecture theatre and B took me through some of the areas of this august institution and we eventually found ourselves in the bar, where the president of the section to whom we were making the presentation greeted us and we all sat down to chat.  At this point I was still feeling quite calm (somewhat to my surprise) even when being introduced to more and more people who I didn't know.  Eventually  it was time for us to make our way to the lecture theatre, took our seats on the dais, and we were introduced to the audience by the president.  It was at this time, having looked at the sea of faces belonging to complete strangers spread out in front of me that I suddenly felt the well-known signs of anxiety overwhelming me; there was no way I could escape.

B started the presentation giving the background to the subject and explaining how a programme (PAERS) had been developed that interfaced with EMIS, the computer application used by 60% of GP surgeries in this country for patient records.  He explained how patients at the practice were asked what they would like to see in an application that would allow them access to their records and this information was incorporated.  It was at this point I got up to demonstrate the system logged in to the database, well I attempted to, but it just wasn't going to play, so I had to resort to using the screen shots which I had seen for the first time about two hours earlier and hope that I remembered the order in which they came.

After my demonstration during which I gave details of how I used the system to book appointments online, order repeat prescriptions and check any other information that I needed to, I handed back to B who completed the presentation.  There followed a question and answer session which had been scheduled for 20 minutes but in fact continued for over an hour.  At the end of it all, a vote of thanks was given to B and myself, and we departed to our dinner as guests of the institution.

Was the evening a success? The answer to that was a resounding yes, on more than one front.  We succeeded in showing the assembled doctors what was already possible as far as patient access to their records was concerned; speaking as a patient I was able to highlight the multitude of benefits that such access allowed me; and we seem to have convinced those present that it was something worth pursuing.  B and I have been invited to give another presentation next year, this time to an audience of GP Registrars, so it will be our chance to show the next generation of GPs what is possible and available.  On a purely personal note, it gave me an opportunity to  speak in front of a large group of unknown people while at the same time being supported by someone who knew how difficult this was for me and who could help me out if I appeared to falter.

I must, at this point, say that I really appreciated the kindness, courtesy, and genuine interest that was shown by all the members of the esteemed institution who invited B to give the presentation and to B for asking me to take part.  What had caused me a certain amount of anxiety before the event, particularly in respect to the audience, and that had caused me to suggest in this blog that I was putting myself in range of the dragon's teeth, actually turned out to be an experience from which I gained some confidence in my ability to do things again that I had not been able to do for so long.  

Thank you ladies and gentlemen, it was a pleasure meeting you all.

Patient Access - Why I Think It Is Important

One of the sad facts of life is that as we get older more things go wrong with out bodies. Some things are fairly minor and are just due to fair wear and tear; these we swear about to ourselves, but don't normally bother the doctor with. Some things seem to be a bit more major. We start to worry about what may be causing the nasty symptoms that we are suffering, and for these we make an appointment to see our GP. Sometimes the GP can put our mind at rest, tell us what is wrong straight away, and give us a prescription that deals with the problem in a matter of days or at worst weeks. However, every once in a while the problem is more serious and our GP has to refer us to a specialist at a nearby hospital.

When we encounter such a situation, no matter how much we tell ourselves not to worry, we can't help it. Our GP probably gives us very good advice, a possible diagnosis, and tells us that our visit to the hospital is just so that we can be sure. The problem is that as soon as the word hospital is mentioned, we probably forget the rest of what is said to us. One of the ways that we can get round this problem is PAERS (Patient Access Electronic Records System). At the surgery that I attend all patients over the age of 16 have the right to use PAERS, which for this practice is provided by EMIS.

This means that I can check what the doctor has written about the consultation; read helpful leaflets that are relevant to any diagnosis by using an automatically created link; I can check when things like smear tests are due, and get the results online; if I have had a blood test I can check to see if the results are in and whether they are normal or require me to see a doctor; I can book an appointment; and I can request a repeat prescription. It also means that I can check on the dates of operations that I have had for when I have to fill in those interminable forms that we all seem to have to fill in these days.

The Department of Health also believes that patients should have access to information, that until a few years ago, doctors felt was for their eyes only. You never saw the referral letter that was written to the consultant, nor did you see what the consultant had to say after you had seen him. At your appointment with the consultant, he would undoubtedly say things to you that went in through one ear and out through the other because you were so worried about what may have been discovered. And doctors do have a habit of talking about things in terms that we, the patient, may not understand, so when we are asked whether we have any questions, we generally say no because we don't know what we should be asking. This is particularly true if you are elderly, or have to deal with everything on your own.

By giving patients access to their medical records many of these things are no longer a problem. But access varies from GP practice to GP practice; and many hospital trusts do not seem to implement the Department of Health's Copying Letters Policy.  I have been very lucky because just recently I have been through the whole process of a hospital referral, appointments, tests, and diagnosis, and I have been properly informed all the way through the process.  As a result of all this the level of anxiety that I suffered has been kept to a minimum, and I have not had to wait too long for answers.  The system is not perfect, but it is certainly a lot better than in the past.

Today I am going to be demonstrating PAERS as part of a presentation being given by B who was my GP until his retirement in the summer.  Although he has stopped seeing patients, he has not stopped working on medical matters including the benefits of patient's having access to their medical records.  This is going to be a big test for me because it will involve me not only demonstrating the application to a lot of GPs but also possibly having to answer questions at the end of the presentation.  So this evening I am going to be going up to a medical education establishment in the centre of London for one of the most nerve-wracking things that I have done in a long time.  But because I see it as something important for patients to be involved in I am going to take this giant step and hopefully give a really good demonstration.

I'm Worried About My Health, And That Of The NHS

Speaking as a patient, I am very worried about the NHS and its future. When I started to read blogs a few months ago, many of those that I started to read regularly were written by doctors and medical students. You may wonder why I was drawn to these blogs in particular, and I suppose the answer would be that many of those written by the doctors are very thought provoking and often allow you an insight into how the NHS works, while those of the medical students are often full of humour, something that we particularly associate with them as a group.

There is another reason why I read these blogs; I'm worried about my health. I don't expect to get a diagnosis from these blogs, I go to see my GP for that, but what I can get is opinion about what is happening in the NHS from one of the groups that has a vested interest in it. As a patient, I am a member of the other group that has a vested interest in the NHS, and it is for that reason that I believe it is every patient's duty to take note of what this government is trying to impose upon us.

The British tax-payer is entitled to get value for money from the things that their taxes are used to fund, they also have the right for politicians to be accountable to the public, after all they are employed by us to do a job, and at the moment they are not doing it very well. If I had performed at work in the way that they have, I would undoubtedly have been given a series of warnings, first verbal, and then in writing; I may even have found my employment terminated by now. Unfortunately, it is not quite so easy to get rid of a government. Gordon Brown has been served a number of warnings from the British public already. The local elections a few months ago sent the message loud and clear, and it has been re-echoed at the by-elections that have been held subsequently. But Mr Brown is determined to go from office having caused as much damage as possible, so that whoever follows has a very hard time putting things right. While he was Chancellor of the Exchequer he was constantly telling us what a good job he was doing with the economy. He was very careful to avoid mentioning that it was the Conservatives who put the economy into a strong position. Since he has become Prime Minister, it has become obvious that he certainly did not do a good job with our economy; we have learnt that that the poor position that we find ourselves in today is in part a result of the way in which Gordon Brown did things at the Treasury, and who he listened to.

Patient participation is not something that should just be talked about; it is something that we should all try to do to ensure that there is an NHS there for us when we are most likely to need it, when we are old and more likely to suffer ill health. This government has a very strong record in tinkering in things that should not be tinkered with, and the results are always bad.

Yes, they may have managed to reduce waiting lists by putting in more money. But huge sums of money have been, and are still being. ploughed into computer systems, that are so complex that they are proving impossible to implement or operate effectively and efficiently. There are also serious concerns about the security of information stored on such computer systems, and yet the government pushes on with their introduction.

Having negotiated a new contract with the GPs in this country, to the satisfaction of both the government and the doctors, the government has now decided that it got things wrong. But instead of biting the bullet and admitting their mistake, the decision seems to have been taken to get back at the GPs by doing everything possible to destroy the wonderful relationship that exists between GPs and their patients. And how are they doing this? By forcing the introduction of polyclinics and health centres, by putting the running of these out to tender, and in some areas, refusing local GPs the right to tender for these contracts. Some GP surgeries are going to be forced to close when these new centres are opened. People will have to travel further to see a doctor, and it almost certainly won't be the same doctor each time that they have to see someone. And why are we being forced down this route? Because the government have decided that they want GPs to open for longer hours to suit a few people who find current practice hours unsuitable. The problem is that this group of people probably need to see a doctor very rarely, so we have the ridiculous idea of rules being set to benefit a very small minority at the expense of the vast majority.

The government is definitely trying to privatise significant parts of the NHS, and this is something that we should not allow. I have said before that the NHS is not a business, and should not be run as such. It is a public service that is there to serve the whole population, no matter their ability to pay for treatment. Primary care should be firmly rooted in the community, and local GP surgeries do exactly that. It takes me a couple of minutes to walk to my local surgery, I am sure that should a polyclinic be introduced into my area of London, then I would have to travel significantly further.

I am asking patients to do their duty. If you want the NHS to continue as a service that serves you and not some far off shareholders, then you should participate in the NHS. Go to your local surgery and see if there are ways that you can join in with patient participation, and let us show the government that they cannot ride roughshod over us.