Can we demand better ways of doing things?

01 July 2015, at 12:00am

THE MERCURY COLUMN in which a guest columnist takes the temperature of the profession – and the world around

WHEN I were a lad, we used to keep a roll of wire and a toolbox in the boot of the car so that when it broke down, as it quite often did, I could fashion a makeshift repair which would be good enough to last until daylight allowed one to get a feel for the real scale of the problem.

Nowadays, not only do I not know where to get a roll of wire but even the act of opening the bonnet of the car comes with a clear warning that such procedures risk serious damage to one’s wallet.

To be fair, modern cars are amazingly reliable and seem to go forever with the bare minimum of attention, which is a good thing because any kind of experimental surgery beneath the bonnet requires a minimum of an MSc in electrical engineering just to get past the engine management system.

Of course, that means the engineers who design the wretched things now know this is no longer a playground for untalented amateurs and so feel little compulsion to make things accessible for mere mortals.

Our pub resounds with seemingly tall tales of how much car repairs actually cost and sillier and sillier accounts of how motor design has gone mad. I know for a fact that, to change the headlight bulb in a car which I owned previously, the garage had to remove and then replace two other apparently useful bits of underthebonnetry.

I imagine that, if I were to work in the motor trade, I would think this is simply a process which reflects the sophistication of modern automotive engineering but the cynic in me rails just a little that the labour cost of replacing an arcanely inaccessible side light bulb in my current car is six times the cost of the bulb itself. Maybe this is simply the cost we have to pay to ensure that our modern cars are efficient and safe.

Perhaps our clients have a point when they question why an x-ray image costs so much or why the printout of an itemised bill for surgery is two feet long. Just how much suture material did this incision require?

What would be great would be for clients to have some understanding of what’s involved in a surgical procedure but maybe that’s a step too far? If we’re honest, much of the time we struggle to get our practice software system to tell us everything we need to know, let alone start an educational marathon for clients.

Even if we have found the holy grail of practice software and are luxuriating in the security of knowing that our practice HAL has everything under control, how often do we find we cannot access the client’s records because the software system either has no concept of the hours we are still working in practice and is performing a strange Zen-like feat of self-introspection relating to an almost cystitic need for backing-up the system or is written in a language which probably makes sense to other NASA workers but remains wilfully ignorant of the language the rest of us speak – a seemingly impenetrable wall behind which the referral notes and pathology reports lie blissfully unaware of our pressing need to access them.

Perhaps it’s because so many of the systems we use are, wholly or in part, derived from systems which were designed to marry up cash registers and patient histories but, in a fully digital age, shouldn’t we be able to access the information we want whether it’s cached in printed word, numerical table, digital image or any mixture of these and relate them to the single, identified record of the patient?

The same patient which is lying in front of us and fully engaged in the process of hanging on to life at least until someone, somewhere can get to grips with what’s been happening to it in the period leading up to this particular moment of crisis.

Expected intolerance

I’m not sure but I suspect that in the throes of canine distemper or equine inflammatory airway disease, the patient may be intolerant of a systems failure to relate contextual information sources to the clinical notes 24 hours a day, even if some of our software systems might feel this is reasonable. After all, what else might a computer do in the hours of darkness than back itself up?

In the US, this problem has reached crisis proportions. EBM is all well and good if you can access the information required to justify a clinical decision at the point when that need is most critical and, in the field of human medicine, the American Medical Association, in recognising that the systems are “taking a significant toll on physicians”, has called for an overhaul of all existing electronic information systems.

The software used across veterinary practices is required to do the same job but now has to work across a raft of different digital devices as varied as desktops, laptops, tablets and even smartphones. As every procedure becomes digitally observed and recorded, that body of knowledge should be accessible to every practitioner who needs it but in a form or format which suits the person seeking to access it.

In the fashionable world of the gadget geek, it’s now commonplace to record, store, transfer and share data about our lives, likes, friends and experiences – a process that has become both simple and cheap to achieve across a wide range of devices.

There is no technical reason why all the clinical information we need cannot be funnelled into a system which is affordable for every practice and accessible on any available hardware.

Modern communicating software can do this and, if we are not accessing it as we need it, we are either using the wrong system or we are not critically demanding enough of the technology that we currently use.

As Dr Caleb Frankel from Philadelphia writes in, “Our profession has some well documented challenges and I would argue that practice software plays a large role. Unless we demand new and better ways of doing things, we are unlikely to get the future we need.”