Posts by Dr Laurie Miles

Another GP take on this

My surgery this morning was considerably delayed by 3 patients who wished to discuss the leters they had received from our PCT. I first informed them that the letter contained a lie (it indicates that a SCR will be formed in May, when in fact the technology locally is not yet available to do this), and that because I do not trust the government to keep the confidentiality of the data sacrosanct, we will NOT be sending ANY data to the SCR for ANY patient.

Extra points - I as a data controller am liable for any breech of confidentiality of the medical data held in our practice. If I am sending the data to a trusted third party, I would expect that third party to indemnify me against any inappropriate data breech sustained to that data after it left my practice (otherwise I am liable... "Dr Miles, did you know that up to half a million NHS employees would have access to my patient's data after it left your practice?"). The NHS has refused to indemnify practices in this respect.

Also, the data will be very valuable, and could earn millions for the Government if sold to drug or insurance companies. All it would take is for a future government minister to declare that the data could be sold in this manner, and I could do nothing about it.

Dr Laurie Miles, GP in St Helens, Merseyside (Bethany Medical Centre)

Virgin 20Mb

I used to pay £37 per month for the XL service - 20Mb. I rang upearlier this year and complained, and got £15 per month knocked off that, as they are charging new customers a lower fee. 1st person I spoke to said it could not be done - had to go higher up heirachy and threaten moving before they listened to me.

Worth giving it a go!

Laurie Miles

Amazing demographic for users of the Wii

I am a British GP. We had a 90 year old granny tell us earlier in the year that she had the best Christmas ever (2007) - she had been playing Golf, tennis, etc. My wife (and my GP partner) was a bit stumped by this, until the patient told her that she had been doing all these activities on the Wii.

And just over a week ago we had a patient in her 70s come in complaining of knee pain. When we asked what was causing it, she told us it occured when she was ski jumping! In fact, she was fine with all the other activities she was doing on the Wii Fit, but every time she did the ski jumping she got knee pain. We told her she should desist from ski jumping, but the patient looked very disappointed...

I need patient data on mobile devices...

I'm a GP, and had computers in our practice for 21 years.

I carry a Windows Mobile device with a cut down version of all of my patients records (encrypted) to enable me to manage patients when I visit them. The alternative is to take reams of insecure paper records - which I have to print out in advance, and which are MUCH less secure and easy to lose / leave behind.

I have a full copy of the practice medical database encrypted on my laptop. Each evening I update that and take it home. If the whole practice burns down, or the server dies before the overnight backup runs, or someone steals the server (lots of physical security in the premises) then I have a working version of the practice database that can be run off that laptop.

My copy of the practice's database is part of our Disaster Recovery programme.

So don't start telling me that I cannot take patient records out of the practuice - it is essential to do so for DR and to enable me to treat patients.

Laurie Miles, GP

I'm a GP too...

Let's look at what happens in real-life. I send a patient into hospital as an emergency with a detailed paper printout from our comprehensive GP computer clinical records (we've been computerised for 20 years), which lists in a structured way their past medical history, recent medication, recent investigations, and recent consultations with me (their GP). The doctor in Casualty says - "I haven't got time to read that" and ignores it. That same patient during that admission gets prescribed drugs to which they are either intolerant or allergic. (The first section of the printout after their address lists Drug Allergies/Intolerances)

The reality is that:

a) A&E doctors are probably too busy to go and log on to the Spine to get the records of a patient (the "security" required means that it takes ages to log on - and do you think that the doctor will immediately log off the A&E workstation when they have accessed the patient's details - or will they leave it logged on to save time when dealing with the next patient in 10 minutes? Anyone see any problem with a doctor leaving an unattended A&E workstation logged into the Spine while they attend to a patient...?)

b) A lot of hospital doctors cannot be bothered to read anything sent in by GPs (patients have also described consultants in outpatients saying to them "I can't be bothered to read this [detailed letter sent by me] - tell me what's wrong with you")

c) The information on the Spine will not necessarily be up to date. A patient may have been seen by someone without the ability to update records on the Spine, and diagnosed as allergic to penicillin. Good clinical practice is to ask EVERY patient when prescribing a drug if they are allergic to anything. The unconscious patient requiring immediate antibiotic scenario is incredibly rare - and they are in the best possible place to deal with any allergic reaction anyway.

d) A simple diktat by the Government would allow access to e.g. pharmaceutical or Insurance companies to patient data (for a fee, of course). Once the data is on the spine, it ceases to be "owned" by the original creators of the data and can be used by the new data owners as they see fit with no real means of sanction from the original data owner. Apart from the fact that if your data on the Spine (most of which will originate from GP) was leaked to an inappropriate third party, you could probably successfully sue your GP for breech of confidentiality!

Not a single patient record from our GP practice in St Helens will be submitted to the Spine undwer any circumstances - I have been speaking out against the scheme ever since it was first proposed, as have many other GPs. Our voices have been completely ignored by central NHS management.

Dr Laurie Miles