[log in to unmask],Net writes:

>I remain unconvinced on most arguments. 
We know this.

> If my partner is seeing one of my patients next door and, for some
>peculiar reason I want immediate access to that patient's records at
>the same time - though why I should, the spirit
>knows - (being the nosey devil I am) I can use the telephone.  

1.  THe point I made was that _he_ might need access to the notes if he
was seeing one of your patients.
Keeping them in your own storage is an improvement on leaving them open
to all in the practice.  The contrast was of course with putting all
the records on one server somebody outside the practice controls.

As for the telpehone, using this does not give you the notes, and does
disrupt both your work and his, as well as the patient's care.  But it
is very traditional.  
The BMJ Paper from the Bristol hospital study by Coeira et al at
http://www.bmj.com/cgi/content/full/316/7132/673
is relevant.

Given that professional pay is the largest expense in GP, wasting GP
time is very expensive.

>As for stats.  Fine, they can and are quite usefully generated within
>the
>practice and anonymised results can be e-mailed to the world, if you
>like. 
>I see no possible justification for linking computers so that others can
>access my patient records - and that seems to be what is being proposed
>on
No it isn't.  Quite the reverse.   And in three paragraphs of detail I
argued that a central solution was less good than _further_
decentralising from where we are at the moment.
Indeed, the point of MIQUEST and suchlike is that others _don't_ access
your patient records, nor do they have to waste your time accessing
them and getting the figures out, they submit a standard query which
returns anonymised data, without taking up your time or your staffs'.
>some spurious ground that it is useful on very rare occasions.   
Again, no it isn't the ground.

>You try to tell MDU & GMC that handwritten notes are of very little use
>!!!
>  In many cases they may be 
That is what I said.  

>but that is largely up to the notetaker - and
>computerisation will be by the same individuals but will encourage
>verbal diarrhoea (like this!!).  
Why do you type longer notes than you write?
If you do, who should be opposing it, if indeed it should be opposed?
	If they are better notes, you should write longer ones.  
	If worse, you should control yourself.  
	I think it is almost always the former.  
>  You have a good subject for research there.  Do computer records
>actually save lives?  Convince me !!
Do paper records save lives?  Or money?

>As for PCGs, the scenario you seem to paint is one where you begin to
>lose  touch with your own patients.  Is that good?
I am a single-hander.  Partnerships lead to a diminution in personal
care and contact, but have benefits which are thought to compensate. 
THe challenge, or one of them at least, is to retain the benefits of
single-handedness, while acquiring the benefits of multiple-handedness
for patients and doctors.
Oh, BTW, we are going to be having PCGs.  It is now a good idea to
think about how to make them work well, rather than how they are A Bad
Thing.

>Over to the IT enthusiasts, again :-)))
Indeed.  Paper, despite 512 years of development, doesn't do the job
sufficiently well.  THere are, for instance, 96 patients on my list of
whom I have no record of their ever having been seen in the Practice. 
THe shortest duration is 3 days, the longest is 1047 days.
It would be a non-trivial task to determine this from a paper record
system, so although I am out of touch with these patients, I know who
they are, and how long I have been out of touch with them.






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