Independent Health Record

Oooer has it been over a month since I moaned on publicly about stuff? I have nothing for those prolific bloggers who manage to post several times a day! But then I am on my own here... etc etc ad infinitum...

My excuse was I went to Spain to ride fast motorbikes and be taught by ex World Champions. Its taken a while for me to come back down to the real world, but something landed in my Outlook inbox today that brought me crashing back to Earth... the announcement of the all Wales Independent Health Record (IHR).

It extolled the virtues of the system for those working in out of hours settings telling of the benefits to patients.

It ignored the fact that at best, most of our clinical records are only vaguely accurate enough to get a decent QOF score. How difficult would it be for instance to correct an inaccuracy after the download day? Especially if a diagnosis was uncertain at the time (e.g. in mental health where diagnoses are notoriously difficult to make on the basis that you can't easily quantify signs and symptoms).

And then there's the small fact that legally, anyone with a half good reason can access the data for their own purposes using Section 251 of the NHS Act (2006). And that's not including those who may inadvertently or deliberately bypass complex NHS IT security systems to have a peak, or be less than fastidious about logging off or leaving printouts or memory sticks lying about. The list goes on.

Anyway, I expressed my concerns via return email which has been intercepted. I am now to be visited by one of my colleagues and a health board project leader for re education to discuss my concerns.

It will be interesting to see what options are available to my patients (and myself and my own kids who are also patients at Single Male Doc's practice down the road) to "opt out" and whether or not such opt outs are publicised ; or will it all be done by stealth? Hmmmmm.....

Section 251

As a diabetic, Big brother knew to get his eyes checked every year...

Sifting through the mail as usual this lunchtime. I am met with a research study from Oxford University which has spread over to Cardiff Uni called ASCEND. Looking at the long term benefits of aspirin and omega 3 fish oils in diabetics. Fair play, I'm diabetic myself and often take part in suitable research like this.

Until I am met with a list of names with all my diabetic patients on!

Hang on. Where did this come from? Has someone sneaked into my surgery in the night, logged on and peaked at our diabetic register then popped out again? Hardly the way for such a prestigious establishment as Oxford Uni to go about things? More worrying was a list of all the names with dates of birth and addresses, including that of my practice nurse and the husband of one of my receptionists.

Concerned re this apparent data breech, I phoned the freephone number and was passed around a few times until I spoke to a research assistant to be told "we got it from the diabetic retinopathy list".

I, like most GPs in Wales, send the names of diabetic patients to the Diabetic Retinopathy Screening Service for Wales based in Pontypridd. They provide a national service to screen all of us afflicted with this insidious illness on an annual basis (or thereabouts!)
It seems that Cardiff Uni, under Section 251 of the NHS Act (2006) have retrieved this data to undertake research and post out lists of names, dates of births and addresses. My name will be on an identical list at my own GP's surgery right now.

Call me naive but I was appalled to be involved in anything that made such blase use of folks' personal data. Research projects I have taken part in before involve coming to me personally and asking for suitable names who are written to to obtain consent with my signature on.

I suppose this is akin to the Gordon Brown's fabled usage of sending mailshots to breast cancer patients.

I telephoned again to register my disquiet at the usage of section 251 and was told my surgery's name would be taken of the list.

None of this bodes well. An example of why I shall resist to the best of my ability any attempt to sign us up for Connecting For Health. We have an "audit" program installed on our system known as Audit Plus which I finally agreed to this year, being one of the last Welsh surgeries to sign up for it, initially to audit our use of the 'flu jab. I will be reviewing this year end and considering whether the time saved by this warrants the intrusion by allowing free flow of data to those who should know better.

Overthrow

It's noticable a the moment, how unelected heads of state are currently being turfed out by the masses taking over the streets.
First it was President Zine al-Abidine Ben Abi of Tunisia (24 years in power) and now Hosni Mubarak in Egypt (30 years head of state).
There are mounting display of disquiet against Ali Abdullah Saleh of Yemen and rumblings in Syria.

So when are we taking to the streets to depose our hereditary head of state, who has sat over us unelected for the past 59 years?

Vive la revolution! http://www.republic.org.uk/

Trouble ahead...

Well, no rantings about the reforms to the NHS here at the moment, being a passive observer from the other side of the border, but an article in the Daily Wail which was pointed out to me by Dr. Grumpy from the US really has me running scared!!!

The World Is About To Run Out Of Chocolate !!!

ARRRRRRRRRRGH!!!

..........oh, hang on, its a scare story in the DM innit? Or is it?

I can commend Dr. Grumpy for the regular daily output of whimsical patient tales and education on interesting facts that get stuck in one's head in place of the dosages for starting gabapentin or the kids' dental appointment times.

Note to self. Learn how to use this Blog thing so I have links in the R hand border. I mean I have 2 followers now!

Well tyred

Mmmmmmm my new slicks just arrived, delivered to the surgery so they sat outside my door after turfing out my last punter. Shiny black and smelling of pure petrolhead excitement.
Can't wait to use them in Spain in half term.

I CAN wait to do my first trackday of the year in Anglesey tomorrow! (Brrrrr!!!)

Own goal!

In a previous life, before deciding to become a GP, I decided that to make people better you had to talk with them for hours on end about their childhood whilst they reclined on a leather couch. Thus I started my medical career as a trainee psychiatrist. It didn't take long to realise the hell of psychiatry, dealing with the mad (whom I felt sorry for) the sad (who made me depressed) and the bad - the latter alas did my head in so much I realised it wasn't for me, though I did persist through to sitting the MRCPsych Part1. I took 6 months out to do a job as a GP registrar and realised this was my true calling so never returned to psychiatry.
Because of this I am now registered under Section 12(2) of the mental health act to be a specialist GP who can make an assessment independent of the local mental health team, as to whether someone suffering with  a mental ailment can be detained against their will. (It's a lot more complicated but I'll keep it simple!)

So I was called out last night at the end of surgery to see a chap by the local emergency social worker. Theoretically  this work covers the whole of North Wales but was surprised to hear this chap was just on the edge of my GP patch.
We traipsed out to the middle of the Welsh countryside. I joined another GP from the next county and 2 social workers.

He was a chap in his early 30s who was a heavy cannabis user and had not left the house for months. He had been released from prison prior to that for attacking a policeman.
Basically the was not "sectionable" in that he had a mild personality disorder (because he told us!) and blamed all of his behaviour on this fact. He seemed reluctant to accept responsibility for his own behaviour. Basically a bit of a twat.

He didn't like going to his doctors as they were on the other side of the county and he "always got aggressive with doctors". Great. An aggressive twat.

I suggested he saw one of my local colleagues whose surgery was within a mile or so of this chap's house so he could more easily access local services.

"I don't like coloured doctors. I'm not racist but my mum was once attacked by a black and white minstrel" (or some such story). An aggressive racist twat, and one who was not willing to leave the house and would be bound to want regular home visits.

I couldn't believe what I said next...
"So the next nearest practice would be.... ummm.... me! (DOH!)"
His eyes lit up "Really? Aghhhh cool! You're that doctor that rides bikes and everything aren't you? Can I have Sativex (cannabis spray) to help me chill out?"

The other GP just gave me one of those looks as if to say "Ha ha! You stupid bitch!"

I immediately felt my heart dipping in and out of my left shoe as if to get some practice in.

Own goal I think.

Cholesterol

Arrrgh! If I see one more article on Yahoo News proclaiming the health benefits of lowering one's cholesterol I think I shall explode!!

Life-saving tests everyone should have

Cholesterol

High cholesterol is a leading direct cause of heart disease and related fatalities in the UK.

It can be caused by genetic predisposition, poor diet and exercise, obesity or a number of other factors.

The good news is you can get tested every few years to keep track of your levels and take steps to treat them if they get dangerously high.

By paying attention to your cholesterol, you could well prevent a heart attack or stroke.

How much money will be wasted I ask myself, from the cumulitive effect of this article and the misleading ads for wonfder-cereals that claim "1 in 2 people have high cholesterol". How many unessecary blood tests, patients' time, phlebotomists' time, nurses' time and GP's time will it cause to be wasted and at what cost?


Nurse, pass the valium please... oh and some statins.

Taking The Plunge

Well, after years of reading others' blogs as I ate my lunch over the keyboard at my desk, I have finally taken the plunge into the blogosphere.

How long will it last? Will I have anything interesting to say? Answers to these questions to follow over coming posts.

It's certainly going to be difficult to add much to the many fine medical blogs around at the minute but I hope anyone who is bored enough to read this will find some interesting bon mots about working at the coalface of NHS Wales (no white papaer here !) and possibly a few bike related postings from my other life as a bike trackday instructor.

Let's see how it goes....