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Professor Anthony Warrens - Easter column

Monday 25 March 2013

Hello Everyone,

When I was a junior doctor my days were filled with finding and collating paper-based medical notes and getting hardcopy x-rays from various parts of the hospital (sometimes including the boots of consultants’ cars!).  One of the most frequent problems in effectively completing a consultation with a patient were those when “the notes were lost”.  It’s hard to escape the feeling that I spent an approximately equal percentage of my clinical time today solving computer-based impediments to accessing clinical information.  I am absolutely certain that I would have had the capacity to see 50 per cent more patients in clinic last week if I hadn’t had to spend so much time sorting out the problems with my “smart card”, dealing with the slow chugging of the database due in part to someone inappropriately “tweaking” the system in our local departmental IT office, etc, etc, etc.  I am not Luddite – like one of the workers in early industrial revolution who broke the “new fangled” machines that were going to take away their jobs.  And when one has access to electronic data, the ability to collate and compare and contrast is much greater than it ever was with paper notes.  However, we make a mistake if we think these developments do not come without their own downside.  When eventually the apparently trivial issues that make using modern IT so difficult – probably simply by virtue of the sheer size of data involved, I wonder what the next set of problems will be.  For surely there will be problems!

One of the issues will involve getting out of our very traditional ways of working.  In medical school we teach you about taking history, performing the examination and then undertaking special investigations (tests).  Increasingly I am being asked to pass opinions on patients who are not actually in the room with me, and who may indeed be on another continent.  It may be possible to take a history (although the lack of the ability to interact with somebody on a one-to-one basis in the same room is clearly a significant impediment).  It is interesting that we may have to develop better strategies for remote history taking.  However, examining people may be a lot harder.  It could be, however, that they can get a better standard of care through tele-medicine, even without the face-to-face contact with their doctors, than they can obtain wherever they are physically.  We may have to learn to make adaptations to the traditional way we practice medicine.  Alternatively, just as robotic interventions now make remote surgery more of a possibility, as remote radiology has been with us for a time and remote pathology may very well be upon us, perhaps robotic interventions for palpating the abdomen or auscultating the chest may become available.

I remember thinking that when I’d finished my training and became a consultant, things would change much less and I would be in a constant pattern of working for the rest of my career.  The speed of change since I became a consultant has been much more rapid than it ever was before that.  What I have learnt is that a good doctor is able to accommodate development and change and looks for and seizes upon, technological and other advances that may improve patient care.

Anthony Warrens

Dean for Education 

Barts and The London School of Medicine and Dentistry

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