The UK General Medical Council found Dr. Persaud had behaved dishonestly and had undermined public confidence in the profession. Some examples of his plagiarism are at the bottom of this article.

But giving Dr. Persaud a kicking is not on my mind. I am more interested in the reaction to the GMC's decision.

The UK media are notorious for building up celebrities only to bring them crashing down. However, in this case the journalists seem to have shuffled uneasily in their ergonomic chairs. A web search will reveal the majority of the coverage is ambivalent, many journalists and others trying to deflect the debate by saying what a good chap Dr. Persaud is and that blatant plagiarism does not mean he is not a good doctor. Fair enough, but let's stay on topic, guys.

In the main, journalists earn expert status vicariously. It takes about 10 years of intensive work to be considered an expert in a field, and few journalists--particularly in healthcare IT--have that experience. Hence, we get the phenomemon of journalists interviewing other journalists, who are meant to be experts but in reality have a superficial understanding of their subject. It is no longer necessary to invest 10 years to be considered an expert. A few hours of web searching and mugging up can give that impression without the hard graft.

Comments allegedly made by Richard Madeley and Judy Finnigan encapsulate my area of concern. It was on their TV programme--which considers itself qualified to comment on life, the universe and everything--that Dr.Persaud first came to media prominence. They have stated they wish to continue working with Dr. Persaud. So it seems professional honesty comes second to presentation skill. Is the Internet taking us to a form of celebrity medicine where the ignorant are led by the superficially informed?

But in New Scientist 23 February 2008 Donald Braben argues that we are seriously deluded if we think peer review can lead to innovation. Peer review might work for the mainstream, he writes, but it excludes radical research. Now this chimes with an exchange between Checkland and Jackson I read when researching a Masters dissertation.

Checkland's Soft Systems Methodology is a way of finding solutions to problems that cannot easily be defined and might only be sensed as a vague feeling that all is not well. Predictably Checkland suggests defining the problem and then "identifying feasible and desirable changes". Part of this identification is for the interested parties to generate options and it was here, as I recall, that Michael A. Jackson argued group dynamics meant the methodology was normative, rather than radical. Groups tend to fall into heirarchical working, he suggested, often with one particular individual or group of individuals dominating this meant that radical solutions would often be rejected by those supporting the status quo.

The same limitation may apply to multi-disciplinary review. In a previous posting I wrote about a presentation by Prof Berg in which he argued computers should support standardised pathways of care which would be continually enhanced by review. On the face of it this sounds reasonable. Indeed the idea is not new. I was proposing it at least 15 years before Berg and I doubt I was the first.

But Berg argued that the review would generate innovation. I doubted it and what I have read and heard about the dynamics of multi-disciplinary working supports my scepticism.

Nor is that the end of the story. Peer review may be part of the future of medical practice, but only part. Wikipedia also quotes Drummond Rennie of the Journal of the American Medical Association:

"There seems to be no study too fragmented, no hypothesis too trivial, no literature too biased or too egotistical, no design too warped, no methodology too bungled, no presentation of results too inaccurate, too obscure, and too contradictory, no analysis too self-serving, no argument too circular, no conclusions too trifling or too unjustified, and no grammar and syntax too offensive for a paper to end up in print."

Trade unions are concerned that such software could be used to support cases for dismissal, but Eversheds reminds us of its double edge. Workers may equally be able to claim they were subject to undue stress, which might entitle them to reasonable adjustments to their job and working conditions.

I attended a healthcare CIO conference at Microsoft in Reading UK last week. Fellow blogger Dr. Bill Crounce showed a short clip of a vision of future healthcare that made use of remote monitoring and also surface computing. Cabinets next to a patient's bed could indicate to a patient or a carer when it was time for medication to be to be taken by coloured rings around the drug containers, for instance.

Such concerns are not fully addressed by technical security, as I have previously argued, secure human systems are also essential. When I was young the escapologist Harry Houdini was a hero of mine. When asked why he found it so easy to escape from the most secure of safes, he answered it was because they were designed to prevent people from getting in not getting out. Recent events show even though getting in to secure IT systems may be difficult, taking large amounts of data out is not.

People need to decide if the benefits of an online record outweigh the risks and in the Bolton pilot they can opt out if they think they do not. But eventually we should all be given sufficient information to make that decision ourselves.

Some may want their GP to be their advocate in such matters, and some may not. When I registered with my GP I was not given an option to opt out of having my information stored locally on his IT system, which at least 7 other people in the practice can access.

Also read this article in the Manchester Evening News about the theft from the Royal Bolton Hospital of patient-based information on a local computer.

I wish you a happy and successful New Year.

It's a sad indicator of the sophistication of UK healthcare IT that it still needs to transfer confidential data by what the US calls "sneaker net" and has only recently been able to transfer computer records electronically between GP practices.

Higher levels of technical security on the planned National Care Records Service should make NHS data more secure, but, as I have said before, technical security takes us only so far and must be underpinned by secure human processes. Recent events suggest we have some way to go.

Not a long way to go to Christmas day, though, so I wish you a joyful and peaceful time.

An episode of the BBC's ClickOnline this morning described how an AIDS clinic in the rural community of Peebles Valley is exploiting wireless to improve care. Clinic and a hospice are several kilometres apart and find it hard to communicate because of the hilly terrain. They have solved this problem by using a network of antennae inserted into tin cans, which focus the full power of the wireless transmissions giving the WiFi network added range.

Nurses and doctors now access the patient database and communicate using Voice over IP (VOIP).

Read the full article on the BBC site.