Like most areas of modern life, general practice has been revolutionised by the computer. But does it sometimes feel as if your doctor is more interested in his or her computer screen than he is in you? Why is your GP so fascinated by this electronic intruder in the doctor-patient relationship, and what is its role in your care?
I'm a big fan of computers in general practice. I think they've brought important benefits in patient care, from making prescriptions safer to driving up standards of care. They also make life a lot easier for your doctor (most of the time).
But there's also a danger they can intrude on your relationship with your doctor, plus there are concerns over the security of the sensitive information they hold.
Paper trail
I started working in general practice just as computers were muscling their way into NHS surgeries, but I remember starting surgeries with a pile of little brown cardboard packets on my desk - 'Lloyd George' notes - stuffed with folded letters, test results and illegible hieroglyphics. Some patients needed three or more packets stuck together with sellotape.
Finding a specific blood result, or a letter from a specialist from a few years ago was a nightmare. If you did manage to find what you were looking for, it took a degree in origami to get all the notes folded and back into the envelopes.
Well-organised paper notes are much easier to use, and the larger A4 folders are definitely an improvement. But even with a helpful summary of your medical history at the front, and clear sections for different types of records, paper notes take up storage space, they're hard to search through systematically and doctors' handwriting can be difficult to decipher - even for other doctors.
Computer says 'yes'
Computerised medical records give me a reliable and accurate summary of your medical history at the click of a button.
I can also check whether you have any major chronic diseases such as COPD (chronic obstructive pulmonary disease) or diabetes, and whether you're due for any checks such as cervical smears or blood pressure measurement.
In fact, the computer will give me a rude reminder if anything is outstanding: 'This woman has not had a cervical smear in the last five years.'
I'll usually check your last few consultations, too. The notes will be succinct, legible (except for a few typos) and have a clear electronic signature so I know which doctor you saw last time, and what thoughts he or she had about your problem.
If we want to look back at what a specialist recommended in 2001, I can quickly search through all the documents that have been scanned into your notes. It takes a few seconds and no paper-folding skills.
I can also see instantly the medications you're getting from the surgery on a regular basis, and which you've had in the past.
Legible prescriptions
Computers help to make prescribing medicines safer for you.
First, the pharmacist is less likely to have trouble reading my spidery writing and so mistakes over dosages and names of medicines should be less likely.
Second, when I prescribe a medicine for you the computer will remind me of the drug's side-effects and whether it might have any important interactions with any treatments you're already taking. It will also tell me if you have any allergies or have had adverse reactions to drugs previously.
Third, the computer is much better at keeping tabs on repeat prescriptions. It's harder nowadays for patients to be on regular medications for years and years without having the appropriate checks and monitoring. The computer tells me when they're due.
Rising standards
Arguably, computer records have meant there's nowhere for GPs to hide
Arguably, computer records have meant there's nowhere for GPs to hide any more. Unlike with paper records, it's very easy for us to check and audit our performance to find out how we're measuring up against national standards. For example, how many of our patients with high blood pressure have their pressure adequately controlled?
The government also finds that helpful. Our pay is calculated using data collected on how we're doing - every few months it's sucked down an electronic pipe to the local health trust, which then works out how much money we're owed.
At the moment I'm finding out how our practice is doing when it comes to treating fungal toenail infections - a common problem with clear evidence-based guidance on how to test for and treat it. The computer found all the relevant cases in the blink of an eye (it would have taken days of searching before).
Computer says 'no'
Even as an enthusiast for computers in general practice, I admit there are downsides. For one thing, computers tend to go wrong. When I can't get into my computer in the morning I'm really stuck. When my printer doesn't work I can waste valuable time fiddling about with cartridges and paper while you twiddle your thumbs.
The information computers spit out is only as good as the information we put in – garbage in, garbage out, as the saying goes. There are special coding systems we use to make sure everyone with, for example, a hernia is coded in the same way. This means a search on hernias should find all the people in the practice who really do have a hernia. But the coding system, and the codes we choose, are not always perfect.
The other major concern is about security and confidentiality. Recent leaks of sensitive information about the public makes even the most gung-ho technophile think twice about the security of an NHS IT system.
We're assured the multi-billion pound project to share our medical records throughout the key parts of the NHS (with many potential benefits for patient care) has security at the top of its agenda. But will it be enough? Some patients are asking for their records not to be included on the system when it comes about.
Barrier to attention?
It always pays to pay full attention to the patient while he or she is explaining their problems. As our professors used to tell us at medical school: "Listen to the patient - he is telling you the diagnosis."
If I have one - or both - eyes on the computer screen I may miss vital parts of your history. I'm also likely to irritate you by making you feel I'm just not interested.
I confess I'm sometimes too interested in the screen. So I try to have it angled in such a way that you can see it and we can both discuss what I'm doing. Patients have even spotted inaccuracies in their records that we've then been able to correct.
I also make a big effort to have looked at your computer records before you come in the room, and to focus completely on you while you're telling me the diagnosis.
Dr Graham Easton works in a London GP practice with around 10,000 patients. It has three GP partners, three salaried doctors and fully computerised medical records. His medical training was at The Royal London Hospital. He's also an experienced medical journalist who has worked for BBC Radio Science and the British Medical Journal.
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