You are trying to concentrate on the fourth problem on the patient's interminable list, but the quality framework reminder on the screen is adding pressure to the consultation.
Can you really risk another heavy-hearted narrative by asking the depression screening questions? And how tight is the cardigan under the overcoat that needs to be arthritically shed to check the BP?
Wouldn't it be great if patients could record their own data, check their own BP and even weigh themselves? Or better still, fill in their own hospital anxiety and depression (HAD) questionnaire?
Just sometimes though, dreams do come true. Our practice now has two 'Surgery Pods'. These are touchscreen devices with weight scales and a BP machine attached.
The Pods have begun to make a real difference to the efficiency of consultations.
Before an appointment, the patient sits in front of a Pod, uses the touchscreen and, within a few minutes, they emerge with their records updated.
Surgery Pods are available from Telehealth Solutions and each system costs £250 a month per site. The minimum contract is for two years. It includes telephone support and a 'swap-out' (replacement service).
The Pod's real advantage is that it communicates with the patient records directly.
When a patient is taking their BP, checking their weight and recording their alcohol consumption, the data is transmitted into their medical notes and is Read-coded to make sure that it is recognised by the quality framework software.
You avoid 'the dog ate my homework' phenomenon of patients reassuring you that their home BP readings were all fine yet somehow they forgot to write down the results.
All this provides you with more time. There are no more long depression conversations as the patient coming for review is instructed to visit the Pod first and their HAD scores are in front of you while they are walking up the corridor to your door.
If you are worried about hypertension on initiating an ACE, ask the patient to use the Pod and monitor their BP.
Panicking patients whose pre-operative assessments show hypertension can now check their BP instantaneously at the surgery - and you can ring them later to reassure or respond to their results.
Nurses' and healthcare assistants' time is released from data recording monitoring.
The Pod is liberating for patients. It allows them to take control of their conditions by providing them with the equipment, guidance and tools to monitor and observe the changes in their condition.
Whether it is hypertension or heart failure, anxiety or depression, the provision of data to doctor and patient enhances clinical outcomes and means patient engagement and autonomy.
It all sounds wonderful. However, we have realised that the very group of patients most likely to need continuing care are the elderly and they are often the people who are intimidated by technology or confused by instructions.
Dexterity is required and instructions need to be clear and simple.
If patients find the Pod confusing, they will give up and opt to go through everything with the doctor instead.
Confidentiality can be an issue and we have had the software redesigned to give minimal information when asking a patient to confirm their identity to the Pod.
It is also important that non-users are unable to see the screen so patients feel secure using the system.
Up to 160 patients a month - from teenagers to 80-year-olds - now use the Surgery Pods, and feedback forms reveal a general level of satisfaction.
As for the future, patient familiarity and acceptability has to be developed further but there is no end to the number of devices that can be attached. Spirometry can be automated and diagnostic finger prick tests such as INR testing can be developed too.
We are also looking to link the Pod to the patient arrival system so that touchscreen arrivals and checking in can also generate reminders for patients to use it.
The Surgery Pod is working hard for us. While it is not the total solution to data gathering, its time-saving attributes will grow as it is integrated into more aspects of chronic disease management.
Dr Ingram is a GP in Radlett, Hertfordshire- More information at www.telehealthsolutions.co.uk,
0800 8600 875 or firstname.lastname@example.org
Surgery Pod pluses...
- Eases doctor component of consultation and allows more time.
- Aids data gathering and reduces workload in hitting quality framework targets.
- The patient becomes involved in managing their condition.
- The computer interface means patients give more honest answers about subjects like alcohol consumption or anxiety.
- Allows repeated use of questionnaires to monitor response to treatment for anxiety and depression.
- Convenient for a list with a high number of commuters because they can use the machine whenever the surgery is open.
- Overcoming patient inertia to improve usage rate.
- The elderly are more likely to be intimidated by the technology.
- Staff need training and need to be able to help patients if they get stuck.
- Issues concerning confidentially (see main text).
- The screen needs to be legible to a patient who has 'left my reading glasses at home'.
- Young children playing with it and occasional technical 'blips'.