Tuesday, March 15, 2011

Tool and use

While at ICEW, I heard two presentations in succession about the benefits of mhealth – what the use of mobile phones, particularly 3G, could be for patients. All sorts of ideas mentioned and all sorts of benefits. I found it very exciting but a colleague sitting next to me found it difficult because there were so many problems of implementation in the way. One he suggested, which I agreed with, is that so much depends on how medical personnel use the technology, which made me instantly think of my own surgery back home. This is good activity theory territory; how people use the tool determines the object of the exercise.

One person here talked about emailing his doctor and getting a reply back by text. I can't do that. I live in the richest corner of one of the richest countries in the world. Our doctors refuse to use email with patients, and haven't even heard of texting. They have a wonderful patient appointment system, but the patients aren't allowed to use it. They have to go to the surgery or phone in to make an appointment. If you're ill you don't want to go to the surgery just to get an appointment, so you phone up first thing in the morning along with everybody else, and you have to keep phoning or leave the phone on ring back for 20 or 30 minutes till you get through. And this is to a village surgery with six doctors and about as many nurses and support staff. They even now have a computerised arrival system, a big plate by the front door with a note on it that say “Touch the screen to arrive”, (which is a bit disconcerting because I have arrived, otherwise I wouldn't be standing there reading the screen).

When I'm in the surgery, I get to know a lot of other people's business. The receptionist takes phone calls and starts talking to the patient about what the condition is. Often the receptionist has to speak loudly and clearly, so everybody in the waiting room can hear and can deduce the caller's identity and condition. There is plenty of technology available that could reduce that loss of privacy, screens round the phone, boosters for the voice so that the signal could be increased rather than the receptionist having to shout but the surgery has never considered installing any of it. (I have great respect for one of the receptionists who has developed a linguistic and grammatical technique that enables her to get information from the caller without telling the rest of the room what that information is.)

All of this technology has been used in this surgery for the benefit of the staff, not for the patient. The communications technology is used to keep the patients at arm's length. Technology that could be used to protect patients' privacy is simply not used. It's a clear lesson that technology never works by itself. If you make a piece of technology available, you always have to take into account how people are going to subvert your intentions for their own purposes.

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