Fax for the Memories

Fax machines were once cutting edge. “I just got a sandwich faxed to my desk!” claimed a colleague in the early 90s.

He wasn’t quite right, as it happens, since only his order was transmitted by fax.

Photo by Griszka Niewiadomski from FreeImages

For those who aren’t sure how a fax works, the gist is that the original document is scanned, converted into a bitmap, then transmitted down a phone line as audio-frequency tones. The receiving fax machine deciphers the tones, recreates the image, and prints it more or less legibly.

Before email, fax was the only way to send a sizeable amount of data quickly without an expensive courier. It made it possible to send letters quickly and, for reporters, to submit articles to newspapers on the day without dictating them to copy-takers.

It also enabled my mother, who lived abroad and had, like most seniors, a keen interest in the weather, to keep me updated without phoning.  I well remember the message in which she said it was SNOWING! (underlined three times). She seemed a bit miffed when I faxed back to ask what she expected from Switzerland in January.

Photo by Martin Wehrle from FreeImages

I also had a relative in the Middle East who liked using fax. She generally rang first to tell me her message was on its way, and her pronunciation was different to most. As my children enjoyed putting it, “Aunt Delia likes sending fux.”

The desktop fax came into existence around 1948, but it wasn’t widely used until the 1970s and 1980s. Some machines used dedicated lines, while others shared with a regular phone by means of a switch which didn’t always work. Well, mine didn’t.

Another snag is that one rarely knew how many pages would come in, so the supply of paper had to be kept topped up. My roll of thermal paper often ran out inconveniently mid-flow, like a loo roll. And the paper, being thermal, was useless for archiving as the print soon faded like a receipt. You’d have to photocopy the image or message to preserve a record.

Photo by Joanna Kopik from FreeImages

Some machines were advanced and did colour, but smaller businesses, like individuals, tended to have basic models and the image definition wasn’t great. When I was arranging the funeral of a cousin, there was a choice of coffins. As it wasn’t clear over the phone how they differed, the undertaker offered to fax over images of each one. This generated a long ribbon of paper with blurred photos that looked identical. Still, I expect the details made little difference to dear cousin Gladys at that stage.

The arrival of email meant the end of the fax for most, but the NHS doggedly continued to favour faxes for important communications such as urgent referrals, citing confidentiality as the reason. Emailing was banned for transmitting patient info – despite the fact that NHSmail is encrypted. Perhaps nobody at the top considered the risk posed by a clutch of paper messages sitting in the out tray of a machine for all to see.

Thus the NHS became the biggest purchaser of fax machines. Some hospitals had over 600 of the things each, and of course GP practices needed them too, using up money that could have found its way into patient care.

Now the NHS has seen the light and the new GP contract decrees that by April 2020 all GP practices should become fax-free. Some already are, but it’s possible that not all practices, or the agencies they deal with, will be prepared to unplug their faxes despite the 17 pages of guidance on the subject. The death throes of the fax, I suspect, could go on for a while.

 

A Family Doctor’s Casebook (part 1)

General practice partnerships are like marriage without the sex, muses Geoff as he installs himself at his consulting room desk.  He knows that kind of marriage. Shoving aside the piles of letters that need answering, he begins tending to the sick of North London.

Geoff is a GP from my novels One Night at the Jacaranda and Hampstead Fever.  Despite his problems and hang-ups, he’s everyone’s favourite. Geoff is a firm believer in the NHS, but the changes he’s seen in the 15 years since he qualified frustrate him immensely.

1 The first patient is a three-month old baby with the Lexus of pushchairs and a Yummy Mummy who reminds Geoff of his ex-wife.  She begins by complaining about the 20-minute wait, and the perennial parking problems within a mile of the health centre. All this is extremely inconvenient as she’ll now be late for her Pilates.

Geoff asks what he can do for her.

“It’s Alistair’s head,” she throws down like a gauntlet.

She’s right in thinking her baby’s skull is a tad asymmetrical. Plagiocephaly is common now that babies all sleep on their backs.  Geoff reassures her that it’ll right itself in time, once Alistair lifts his head and becomes more mobile.

FreeImages.com/Johan Graterol POSED BY MODEL

Yummy Mummy is sceptical. “Doesn’t he need one of those special helmets?”

Geoff explains that there’s no evidence they help.

The mother seems unconvinced. She’ll probably go and splash out thousands of pounds on a contraption that will only cause discomfort and inconvenient. Still, she’s now ready to move on to the next symptom. The practice has a new policy of one symptom per consultation, which Geoff routinely ignores. It’s demeaning to patients and wastes everyone’s time in the end.

The rash on Alistair’s buttocks looks like a common yeast infection which should soon respond to the cream Geoff recommends. This pleases the mother, until Geoff asks her not to leave Alistair’s dirty nappy in his consulting room bin.

“I don’t want to stink out the car,” says Yummy Mummy.

Geoff eventually persuades her to take the offending object away, even though he thinks she’s likely to dump it in the waiting room on her way out.

2 Next it’s Mr Legg in his nineties, with an aching left knee. Sometimes it’s his right knee, and sometimes it’s both, which is no wonder since both legs are badly deformed by arthritis. He attends the health centre every couple of weeks, yet refuses hospital treatment. As he puts it, “I don’t want to be a bother. There’s plenty of younger folks who need it more.” Mr Legg adds that he doubts it’s arthritis anyway.  “It’s probably just down to the shrapnel what got me during the war.”

Geoff asks where the shrapnel got him.

“In a little village near Germany, Doctor.”

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3 It’s a relief to see that young Mohammed’s eczema is improving. For a long while, his mother believed that a mild steroid was totally unsuitable for a three-year old, but the cream, along with emollients, has made a huge difference. Mohammed sleeps well now that he doesn’t scratch himself to ribbons. All in all, he’s a happy chappy, apart from a streaming cold that’s not a problem until he flings himself at Geoff and plonks a kiss on his cheek.

Geoff usually washes his hands between consultations. Today he washes his face as well.

FreeImages.com/Toni Mihailov

 

4 Now a young man sits before him. Unemployed, with a squat nose and tats up one arm. “Pain in me bollocks,” he says.

Might be a torsion. Uncommon in adults, Geoff knows, but, unless treated promptly, it can lead to gangrene of the testicle.

“Right. I need to take a look,” Geoff says, pulling the paper curtains across.

As he waits for the fellow to undress, he wipes the photo on his desk with a tissue. It’s Davey, aged four, at the beach in Norfolk. Happy days before the divorce.

“Ready yet?” Geoff calls out, increasingly aware of how late his clinic is running.

“Yeah. Course.”

Turns out the man is sitting fully clothed the other side of the drapes.

Patiently, Geoff explains what he needs to examine. Another three minutes pass while the man undresses.

On examination there’s nothing abnormal about the patient’s tackle, apart from the stink. Geoff peels off his gloves and flings them in the bin. “Hmm. All’s well there. When did you first get the pain?”

The man shrugs. “Maybe a week ago. But I ain’t got it no more, like. Not since I pulled that bird the other day.”

“Fair enough,” says Geoff, even though there’s nothing fair about it. The ugly, unemployed fucker gets laid just like that, while he, Geoff, has been celibate for ten months and counting.

***

Coming up soon, Geoff deals with a very personal problem. Meanwhile you may enjoy one of these posts:

How to Alienate Your Doctor in Ten Easy Steps

What Your Doctor is Really Saying

or, on a more serious note, an overview of sepsis in The Disease Nobody Knows About Until It’s Too Late.

How to Alienate Your Doctor in 10 Easy Steps

Articles in newspapers and magazines often give advice on how to get the best out of your doctor. The idea is to maximize the benefits of a consultation and to relieve pressure on the NHS at the same time.

National Health Service logo

But where’s the fun in that?

With a little planning, you could properly annoy your doctor instead. Here’s my advice based on decades working in the NHS, together with one or two favourite tips from my fictional GP colleague Geoff, the doctor in Hampstead Fever.

Hewlett Packard Rapaport Sprague stethoscope

I like to think these are steps almost anyone can take.

1 Prepare for your appointment by not showering or washing for two weeks. Don’t wash your clothes or change your underwear either. With clean clothes, you’re just not playing the game.

2 Bring a list. It should include all the symptoms you’ve had in the last five years. Aim for about 20 or so different complaints.

3 if you don’t have enough symptoms of your own, bring the family. A babe in arms, a couple of hyperactive toddlers, and a deaf granny should do the trick.

4 Kick off the consultation with, “This won’t take a minute, doc.” Which is true. It will take an hour.

kitchen-clock

5 To help your doctor’s diagnostic skills, offer a couple of well-chosen newspaper cuttings or internet printouts. You know the kind of story: Vaccines Kill Millions, or New Miracle Cancer Drug. On no account must you allow your GP to dissuade you. After all, Dr Google is so much better than a living breathing doctor with actual qualifications.

6 When the baby’s nappy needs changing, leave the soiled one behind in the doctor’s bin. This ploy is a good one for the summer months.

7 It’s only polite to take your chewing gum out before saying, “Aah.” Leave it in a tidy blob on the GP’s desk.

8 Exhibit your verrucas, ingrown toenails, chilblains, or bunions at every consultation (what do you mean, you don’t have any?). Before you put your sock back on, it’s de rigueur to get it the right way round by shaking it vigorously at your GP.

sock

9 Don’t ask for an antibiotic for your cold. Demand one. You know your rights. If necessary, remind your doctor that you pay his or her wages.

10 Save your best symptom till last, and mention it only when you’re about to leave. Thus, hand on the doorknob, you can say, “While I’m here, doc…”

FreeImages.com/Robert Eiserloh

With a bit of practice, you should be able to piss your doctor off without even trying.

***

For the really perverse who actually want to get the best from their doctor, here’s my advice, along with some wisdom from fellow GP Mark Porter in The Times.

Warning: A Doctor Rants

Vaccines had a bad press a few years ago, but things have changed, or so I thought. That’s why I was surprised when this week a university student refused the freshers’ dose of meningitis C vaccineFreeImages.com/Antonio Jiménez AlonsoI was even more surprised when he told me that his father, a doctor in another European country, was against vaccination.

What would you have done?  

University students are at higher risk of meningitis. One in four 15-19 year olds carries meningococcal bacteria in the back of the throat, as opposed to one in 10 of the general UK population. And, if you haven’t been a fresher for a while, imagine all that mingling with hundreds of other young people, often in crowded conditions.  

There’s lots of useful info on meningitis, and on vaccines.  Alas, I only know sites for fluent English speakers, and the lad in front of me wasn’t one of them.

I jokingly told him I wanted words with his dad. But in reality that was never going to happen. In general practice there’s barely time for a long discussion with a patient, let alone with family. Photo by Jean Scheijen FreeImages.com/Jean ScheijenConsultation rates with GPs have gone up in the last 20 years to around eight consultations per person a year. Along with that, patient expectations have risen. No bad thing in itself, but it requires more time.

Many areas are bulging with an influx of new patients. London has a particularly mobile population but it’s not the only place where there are migrants, refugees, or simply new housing. Some arrivals speak little English, so interpreters are needed, and the consultation takes twice as long as a result.

The pattern of work has shifted. As hospitals shed more care onto general practice, and send patients home sooner, GPs inevitably must do more. Around 90% of medical care now takes place in surgeries, by GPs, nurses and other members of the health team.

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The structure of health care has changed with the advent of clinical commissioning groups (CCGs). In my view, that work takes a lot of good GPs away from face-to-face patient care.

Professional development makes demands too. I have to keep up to date, and these days I also have to prove it via appraisal and revalidation. People believed something had to be done post-Shipman, so now we spend time counting lots of things that don’t count. I hope that changes, but meanwhile preparing for annual appraisal takes two hours a week.

Providing good medical care is now a real struggle. GPs are retiring, and a sizeable chunk of medics are leaving the country.

Australian and UK towels on the beach

There’s nobody to replace them.

Like many GPs, I teach medical students. That time too must come out of a busy week. But here’s what really worries me about teaching.  

In the last 10 years I’ve noticed that fewer students now want to be GPs. Yet not so long ago new doctors were falling over each other to join practices.

It’s no wonder that doctors in the UK are angry and fed up. New changes imposed by government are likely to make things worse. In many areas, NHS general practice can barely provide a decent service five days a week. How can it stretch to seven days?

I’m not against change. General practice changes all the time. That’s part of its attraction as a speciality. But the developments I’ve lived through now make it almost impossible to do the job properly.

doctor's bag

You may like to read: 

Numbers of NHS doctors registering to work overseas could reach unprecedented record in the Independent, September 21, 2015

A fictional GP reflects on What They Don’t Teach at Medical School

I muse on What Happens when You Become a Doctor.

Easy tweet: What’s wrong with general practice? http://wp.me/p3uiuG-15w A #doctor rants #NHS via @DrCarolCooper