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Healthcare IT: no evidence

cane.jpgGeorge’s nightmare began with a succession of illnesses. At the beginning of the year he endured agonising head pain for a week after he was discharged from hospital. He was eventually readmitted, and medical staff discovered he had a bleeding capillary in his head. After some persuasion from my Mother--they are of a generation that prefers not to disturb doctors “unnecessarily”--he had called the out-of-hours GP service, but the doctor attending said he could do little because he did not have George’s medical record, thus lengthening the agony. But they say there is little evidence to support the use of ICT in healthcare.

Last week my Mother tried unsuccessfully to call George for several days. After calling his family and even sending an acquaintance round to his house she thought she had done all she could. After all, he was the customer of a care service that checked his well being with telephone calls and that would send someone around if there was no reply—except it didn’t.

He was found on Thursday lying paralysed and unable to speak on his bathroom floor having suffered a stroke on the previous Sunday evening. Of course, the technology to monitor remotely is available, but they say there is little evidence to support the use of ICT in healthcare.

I have been reading Max Pemberton’s Trust Me I’m a Junior Doctor in which he relates his experiences of the UK’s National Health Service. I worked in the NHS for 10 years and many of his anecdotes brought on a wry smile of recognition.

When I was studying for an MBA I remember learning about corporate culture (now an overused and devalued term) and how it might be described using myths, heroes, legends, stories, jargon, rites and ritual. An NHS manager on my course suggested the consultant’s ward round as an example of a ritual. In it the medical consultant and a retinue of junior doctors progress through a ward reviewing and discussing patients. An extreme example can be seen in the film Doctor in the House (1954) when the formidable Sir Lancelot Spratt humiliates his underlings.

Max Pemberton was also at the bottom of the pecking order, because he’s packed off to get the coffee and croissants for the round. That seems poor reward for the time he spent excavating X-ray films from behind radiators and tracking down missing pathology samples and results in preparation for the ritual. He even has to transpose manually drugs charts by interpreting the glyphs of senior medical staff. But they say there is little evidence to support the use of IT in healthcare.

A rigorous scientific approach to medicine is to be applauded; but using demands for “evidence” as a way to slow down IT adoption in the face of common sense is not.

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