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.”

doctor's bag

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.

What Your Doctor is Really Saying

Confused when you see the doctor? It’s no great surprise. Medics are famed for their jargon. But, even when they remember to use simple English instead of medicalese, they come out with euphemisms and other phrases that conceal what they really have in mind.

FreeImages.com/Carlos Paes

I know, because I do it too. Now, with the benefit of years of experience, I can help you decode what your doctor really means.

What the doctor says

What the doctor really means

I see you’ve brought a list. Splendid! Now we’ll be here all day.
Any thoughts yourself as to what it might be? OK, what did you find on Google?
As it happens, my colleague has a special interest in your problem. I’m all out of ideas.
It’s a classic example of Tsutsugamushi Fever. Never seen a case of it, but doesn’t it sound grand?
You’ve got a case of pendulum plumbi. You’re swinging the lead.
I think I should examine those feet of yours. Hope you’ve had a bath recently.
Or perhaps I’ll get Nurse to send toenail clippings to the lab. Actually, I’m bloody sure you haven’t.
I’m not in the slightest bit worried, but I think you should go to A&E just to get it checked out. I’m shitting myself.
This won’t hurt a bit. It’ll hurt a lot.
Now just a little prick with a needle. Now just a little prick with a needle.

 

So, with the benefit of this little chart, you can make the most of your next appointment. If you can get one, that is.

National Health Service logo

 

Feedback Frenzy

My pocket chirrups as I descend the steps from my bank. The text message asks me to rate my recent customer experience. This happens to be one of a hundred or more perfectly routine transactions I’ve made at that bank.   

FreeImages.com/Simon Stratford

Irritated, I delete the text.

At school, there was a girl who was forever checking what people thought of her. Sadly, the answer was ‘not much’, but this didn’t stop her beaming at everyone and trying to decipher their expressions.  When she couldn’t read the emotional temperature, she would ask what we thought. I wince to report that we thought our classmate stupid. Looking back, however, she was well ahead of her time.

These days, Waitrose sends me emails asking how my groceries were. Would I rate and review them?

waitrose-redcurrant-jellyI get similar requests after almost every commercial interaction of the day. If not during it. A text thanks me for travelling with Addison Lee, and invites me to rate the driver. I get this message before I’ve even reached the destination.

Ditto Moonpig, who want to know how everything went with the card I ordered. It’s not even scheduled to be delivered till next week. Stop asking me!

Now an email thanks me for collecting my parcel from the Spar in Chesterton Road, and asks me how I would ‘rate the service in store’.

The bottom line? It was fine. I got my parcel. Had the guy behind the counter not found it, or handed me a damaged parcel or something entirely different like a Mars Bar or a lottery ticket, you can be sure I’d have let someone know, loud and clear.  FreeImages.com/Tony CloughFeedback can certainly be useful. Book reviews, for instance, help guide the author as well as people looking for their next read – though it’s worth noting that the most useful reviews have actual words in them, not just a star rating.

Evaluations from the students I teach can also be valuable, if they help improve the outcome for the next lot.

For feedback to be most useful to others, it pays to ask the right questions. One pension provider invites me to rate my recent dealings with them. A more pertinent point might be whether I was happy with the return on my investment.

Nowadays, detailed feedback from patients is an integral part of a doctor’s appraisal process. It’s a two-page form that demands a certain level of literacy and attention. That makes it difficult for many patients, especially those who’ve just had bad news or been sent to hospital.

Feedback from colleagues is even harder to come by. In smaller practices, family doctors may resort to asking people they haven’t worked with for years, just to make up the numbers.

National Health Service logo

Feedback shouldn’t be just about collecting all the data we can, because we can. To have any value, it needs to be more selective, and to ask the right questions at the right time.

***

If you’ve read a book you enjoyed lately, please think of leaving a review on Amazon or your favourite reading site. It doesn’t have to be long, just your overall impression and anything you’d like the author and prospective readers to know.

Here’s more detailed guidance, should you feel like it: How to write critical book reviews – and why I think you should, by Debbie Young.

bookshelf crop

What Happens When You Become a Doctor

Any day now and it’ll be the Killing Season, so-called. August 1 is the date when a fresh crop of newbie doctors arrives on hospital wards, bursting with enthusiasm and theoretical knowledge but woefully lacking in experience.

Jeremy's scalpel

In fact August is no longer worthy of that macabre tag. The month now begins with a sensible induction process for newly qualified doctors, with proper training in the tasks and procedures they’ll need to do in the coming months. Gone are the days of ‘See one, do one, teach one.’ The Killing Season is well and truly dead. Induction is a recent trend. I will never forget the utter panic on my first day as a doctor as I crept around in squeaky new shoes trying not to look like the rawest recruit. It was a Sunday—was there ever a more stupid day to start work?—and a patient had the misfortune of dying within 45 minutes of my arrival at the hospital. Now don’t jump to conclusions. I hadn’t even seen her before she died.

HP Rapaport Sprague stethoscope, circa 1981

HP Rapaport Sprague stethoscope, circa 1981

Wet behind the ears, I had no idea of the procedure to follow. Even scarier was the realization that I had two whole wards full of people to keep alive as long as possible. I rushed round to say hello to them all and check they were still breathing. At the same time, I said goodbye to many things: sleep, leisurely weekends, sitting on the loo without being bleeped. In short, to normal life. iv nutrition

While a lot has changed since then, including working hours, some things haven’t, as I realized from a recent blog post by Salma Aslam (by which I mean Dr Salma Aslam) Transitional state: med student to doctor It all came back to me. When you graduate from medical school, you may get a number of different reactions. 1 “Well done, but don’t go round thinking you know it all.” Don’t worry, I didn’t. And still don’t. 2 “So what?” That’s what I got from a group of arts students sitting around in the bar. They acted like they couldn’t care less about my news, but they were probably envious. 3 “Can you have a look at my verruca?”

plantar warts

Count yourself lucky. It’s much worse to be subjected to the long saga, in multiple episodes, of their entire medical history. This is when you get envious of those jobless arts graduates. 4 “The only thing that works for my migraines/arthritis/autism is kinesiology/homeopathy/acupuncture.” The implication is that allopathic medicine does nothing. Well, I’ll keep an open mind about that, only not so open that my brain falls out.

tablets

5 “You should get a job as a medical adviser on Casualty or something.” Yeah, right. Like nobody else with more experience wants to do it. 6 Perhaps the weirdest reaction was from my mother, who insisted I should now call her Dr Cooper. Why? “Because my daughter is a doctor, it’s like I’m the doctor. You may congratulate me now.” Get used to all of it. It may be a while before you hear the most welcome response of all: Thanks, doc. I feel a lot better.”

medical bag

Easy tweet: What happens when you become a #doctor? http://wp.me/p3uiuG-12N via @DrCarolCooper #medicine

Six Lessons from the Eye Clinic

Today Sanjay takes his mother to her hospital appointment.

He’s a nice young man, a character from my novel One Night at the Jacaranda. Although I made Sanjay up, maybe you know someone like him?

He and his mother walk past a sign warning of the symptoms of Ebola.

Not surprising the font on the sign is massive. This is the eye clinic.

1138666_78954230 medical eye

The morning is a learning curve. They arrive at 9.30am to find there are over 40 patients there already.

Beta, I should have brought chair from home,” says Mrs Shah. Here comes Lesson One: in addition to bringing glasses (including bifocals), appointment letters, and any medication they are taking, in original containers, patients should bring something to sit on.

The only empty seat belongs to a man who’s just gone to the loo, which doesn’t flush, as he explains to all and sundry on returning to waiting-room.

A poster on the wall advises patients that clinic visits can take up to four hours. The notice on a board by the receptionist says the clinic is running 90 minutes late. Sanjay isn’t sure if this time should be added to the four hours, or whether it is already part of it. Nobody knows. Lesson Two: don’t ask stuff. Just accept it may take some time.

They stand in the corridor for a while.  A nurse emerges from somewhere and calls out, “Philip Nutmeg” or something similar. When Mr Nutmeg fails to respond, she says it again, looking meaningfully at Mrs Shah. Sanjay says helpfully, “She’s not Philip Nutmeg.”

The nurse glares at him.

Frame on eye chart

Eventually Sanjay’s mother is summoned into a little room to have her vision tested by another nurse, and to learn Lesson Three: computerised medical records do not necessarily contain any medical records. The entire hospital went computerised two months ago, this nurse says, but there are no clinical data on them. So Mrs Shah gets to recite her entire medical history. She looks over the nurse’s shoulder to make sure she writes everything down.

When they come out again, a cleaner in a hijab is here to deal with the loo. And Philip Nutmeg still hasn’t shown.

Lesson Four: nobody gives old people a seat, not even when they are rubbing their knee and looking around hopefully.  It shocks Sanjay that not one person has stood up for his poor old mother.  He considers ejecting someone forcibly, but then his mum isn’t as old or as poor as some of the others.

In the corridor there are two wheelchairs blocking doorways. In one, a woman with one leg. In the other, a man (or possibly a woman). This person has two legs, but Sanjay is not sure about the face because it’s covered with a blanket.

There’s also an old man pushing out some zeds and a younger man who reeks of alcohol. It is 10.45am.

Sanjay notices a woman with a pinched face and a jute bag bearing the name of a firm of solicitors. The doctors will love that, thinks Sanjay.

One of the doctors appears now to find out what’s wrong with the man with the blanket on his head. He insists there’s nothing wrong, but the light hurts his eyes.

Lesson Five, thinks Sanjay: bring dark glasses to the eye clinic because the lights can become unbearable once you’ve got dilating drops in your eyes. Now the man in the wheelchair is mighty pissed off because the doctor has asked him not to cover his head with the blanket. “It scares us, you see. We think something‘s wrong.”

Sanjay’s not so sure. He reckons you could die in the clinic and not be noticed.

The crowd eventually thins out and they get somewhere to sit.  Sanjay’s stomach is rumbling, and so is his mum’s. Lesson Six: bring something to eat.

989041_50471101 baguette

By the time they’ve been there three and three-quarter hours, Sanjay’s mother has had her visual fields tested and her corneal thickness measured, and her pupils look as wide as a dead cat’s. She’s also gone into the inner sanctum, where the consultant sits at a desk in front of a large cutaway diagram of an eye. This is worrying. Shouldn’t the doctor know what eyes looks like by now?

The medical verdict is not too bad. Mrs Shah’s eye pressure is fine today, and her cataracts don’t need doing yet.

Unlike a patient leaning on the front desk. There’s only one receptionist left, and this patient is pleading with her to expedite his cataract surgery because it’s very urgent. Unfortunately, the receptionist tells him he’s only on the routine waiting list.

By the time Sanjay and his mother leave, there’s just one man left in the waiting-room. Maybe it’s Philip Nutmeg.

1221586_15421511 nice eye

Just a Little Prick with a Needle

Today’s tests are no biggie. Nothing like the ones Sanjay’s had in the past. Anyway, he’s feeling better than in a long time.

There’s already a queue of blood test patients waiting to be interrogated at reception. You only get a numbered ticket once the bossy boots at the desk finds out if you’re fasting.

NHS

Sanjay gets number 79. The display on the wall says 46. No wonder the place is packed. Pretty soon he’s finished reading the Metro. So he reads people.

The girl next to Sanjay isn’t fasting. She’s shedding sugar from her donut all down her ample front. Fact: nobody who eats donuts ever looks as if they need to eat. And right under the sign that says no eating, drinking or assaulting NHS staff, a man is chomping into a burger. A ketchup sachet lies at his feet.

The plastic chairs are hard. Sanjay wishes he weren’t so skinny. There’s also a bench for urgent patients. The urgent patients look terrible, as if expecting to snuff it while waiting. He was on that bench not long ago, but now he’s been promoted from living dead to living living.

It’s number 67 now. The snoozing woman in the seat next to Sanjay wakes with a start when her walking-stick falls over. Walking-sticks always do. You’d think someone would design a solution.

Some people have brought their entire family, along with their shopping, scattered in carrier bags in and around the chair legs. A toddler with a cold studies Sanjay then removes his finger from his nose and wipes it experimentally on the arm of the chair.

The phlebotomist who finally calls Sanjay isn’t just a phlebotomist. The badge says he’s a cannula technician too. He is about 5’3” and one of his spots is threatening to erupt. He only opens his mouth to ask Sanjay to confirm his name and date of birth. Blood is taken wordlessly. It’s important to make patients feel at ease in today’s patient-centred NHS.

test tubes

Out Sanjay goes, clutching a cotton wool ball to the crook of his elbow.

The imaging department is at the other end of the hospital, down a draughty corridor guaranteed to give you double pneumonia if you don’t have it already.

Nobody’s eating in x-ray. They’re too busy figuring out how to sign in. For chest x-rays it’s straightforward because you can go anytime Tuesday to Friday from 9 to 11am and from 3 till 5pm. He doesn’t like to ask what the hell they do 11-3, not to mention all day Monday.

If you have an appointment, a state-of-the-art machine scans your letter. If you don’t have an appointment, you go to the desk. There’s a third machine that dispenses numbered tickets.   A young man in a moon-boot is waiting patiently while someone tries to fix that one.

Sanjay hangs around the desk while a receptionist makes a hash of explaining a test to the patient in front of him.

Finally Sanjay is told “Take a seat and you’ll be called by your name.” He thanks his lucky stars he’s called Shah, not something like Sivaramalingham. He sits by a wall decorated with enticements to give blood, volunteer for the League of Friends’ shop, give up smoking for good, get help with your alcohol problem, report domestic violence, and donate your organs as soon as you finish with them.

There’s a lot more activity here than in blood-testing. For one thing, there are two calling systems. The staff have the knack of calling out a patient’s name at the exact same time that the automated system calls out numbers. Means nobody can hear either announcement, so patients keep getting up to ask what’s going on, then coming back to their seats, head shaking in disappointment.

One patient has got the system figured out. Now she’s giving out to all and sundry the phone number of the professor’s PA, which is, she reckons, the only way to get your x-ray done and have the results sent to your doctor in the same century.

Only the old man next to Sanjay is immobile. He’s wrapped in so many layers of woolly clothes that he has to sit bolt upright. Probably been wearing them a while, judging from the smell.

Sanjay needs the toilet but it’s out of order. This means a trek halfway round the hospital to find one that works. He could have just asked at the desk for a dozen specimen containers and filled those.

hospital gownFinally it’s his turn for x-ray.  

He is shown into a cubicle and handed a gown. Then he studies the grainy instructions on the wall.

Sanjay tries to tie it as per the picture, but fails. Ah. Two of the tapes are missing.   He goes into his x-ray bare-chested like Putin.

The radiographer tuts.

Two hours for two simple tests. Finally Sanjay breathes a sigh of relief and exits to the fresh air, rushing straight into a crowd of smokers by the revolving doors.

 

Next week it’s the London Book Fair. I look forward to meeting friends old and new, and reading an excerpt from my novel to fellow indie authors. I have yet to choose the passage, but you can bet Sanjay will be in it.