NHS could save billions replacing paper with really expensive machines....

[EternalOptimist]

the NIHS

not invented here service

[mudskipper]

<whinge>

Got underactive thyroid and am permanently knackered - proper knackered.

Been on meds for 3 months now, with little improvement. Did lots of research, and printed off academically rigorous stuff from endo journals showing that although the accepted normal range (in the UK) for TSH (thyroid stimulating hormone) is 0.5 - 5 (apparently based on 97.5% of the population), 95% of the population have TSH < 2.5, and the median value is < 1.5. Tried to use this to argue that, with a TSH of 3, I may not yet have reached the optimal levels, and that we should aim to treat the symptoms, not the numbers, at least until I am either feeling better, or values closer to the median. Doc's attitude was 'computer says no' - her flowchart says that once TSH < 5, I am cured.

Anyway, point of whinge is that many GPs are indeed treating according to a standard model with no real interest in tailoring to an individual patient's needs. At least in McDonald's I can get my burger without gherkins.

</whinge>

[vetran]

Umm, is standardisation really the way forward? You have to be pretty damn certain that the standards you apply are right, because if they aren't then everybody ends up screwing it all up and you'll have no successful examples to follow.

I don't think the comparison with Starbucks or MacD really holds water; healthcare is quite a lot more complex than making coffee or hamburgers.

Booking bed's, appointments, meeting / operating rooms is pretty standard.

They aren't even doing this right, its a bit like turning up at NASA and being presented with cold water & milk when you are offered coffee. You know you don't want to go up in their rockets.

Its not rocket science they just try to make it look like that.

I have turned up a couple of times to have machine X attached to me for 24 hours, an appointment I waited for 2 months, I turn up on time, wait the usual 90 minutes after my appointment and find that they are out of machine X or its faulty. This experience is fairly common as far as I can tell.

Once I can get an 'urgent' appointment in 7 days, turn up on time and be seen on time ,yes I know doctors are busy, appointments can vary etc. but if I'm having to queue in a regular surgery to have a standard 7.5 min review it should be on time give or take 15 minutes not 4 hours.

We aren't talking about anything clever its resource scheduling and patient manipulation, a Hotel booking system would do most of it. Add a CRM system and you have half the problem solved.

I think people are over thinking most of the problems, I'm assuming BUPA & so on have a suitable tool just as US (and other nations) hospitals do. Buy one of their systems off the shelf and turn off the invoice issuing part.

[Mich the Tester]

<whinge>

Got underactive thyroid and am permanently knackered - proper knackered.

Been on meds for 3 months now, with little improvement. Did lots of research, and printed off academically rigorous stuff from endo journals showing that although the accepted normal range (in the UK) for TSH (thyroid stimulating hormone) is 0.5 - 5 (apparently based on 97.5% of the population), 95% of the population have TSH < 2.5, and the median value is < 1.5. Tried to use this to argue that, with a TSH of 3, I may not yet have reached the optimal levels, and that we should aim to treat the symptoms, not the numbers, at least until I am either feeling better, or values closer to the median. Doc's attitude was 'computer says no' - her flowchart says that once TSH < 5, I am cured.

Anyway, point of whinge is that many GPs are indeed treating according to a standard model with no real interest in tailoring to an individual patient's needs. At least in McDonald's I can get my burger without gherkins.

</whinge>

I can sympathise, but the crux is in the term 'many GPs'. Indeed, in any organisation most people in the same job will do that job in a similar way, BUT, by standardising you can discourage the few who will try to do things differently and thereby possibly lead improvements to how the job is done.

[minestrone]

Doctors love people who turn up with print outs from the web, 15 minutes on google equals a medical degree don't you know.

[bobspud]

Umm, is standardisation really the way forward? You have to be pretty damn certain that the standards you apply are right, because if they aren't then everybody ends up screwing it all up and you'll have no successful examples to follow.

I don't think the comparison with Starbucks or MacD really holds water; healthcare is quite a lot more complex than making coffee or hamburgers.

No it is not. At the root of it is a set of workflows that end in a cure, containment or a death. They are many more workflows than making coffee I admit. but if you have cancer in Scotland or Surrey it should not make a difference.

Diagnose
Discuss options
Treat
monitor
discharge the patient or retreat
Handle palliative care
Discharge a body

Letting 50 different trusts handle that process in their own way is ludicrous. Letting them think that they and only they need a patient system and that it should be custom to their own ways of doing things is a massive mistake. I am sure that there are hundreds of admin staff that would say but my ways better than that because I designed it. but its those guys that need to be shown a door...

[vetran]

I think that diverse approaches are more likely to lead to progress than standardisation.

Once you have > 80% of the throughput being dealt with efficiently then you can go off and do clever things with the outliers, until then you need to standardise.

Currently 80% of the organisation is screwed up.

[Mich the Tester]

No it is not. At the root of it is a set of workflows that end in a cure, containment or a death. They are many more workflows than making coffee I admit. but if you have cancer in Scotland or Surrey it should not make a difference.

Diagnose
Discuss options
Treat
monitor
discharge the patient or retreat
Handle palliative care
Discharge a body

Letting 50 different trusts handle that process in their own way is ludicrous. Letting them think that they and only they need a patient system and that it should be custom to their own ways of doing things is a massive mistake. I am sure that there are hundreds of admin staff that would say but my ways better than that because I designed it. but its those guys that need to be shown a door...

I'm not talking about admin staff but medical staff; they need the space to use the brains they've trained during the years of very expensive education they've been given.

[vetran]

I'm not talking about admin staff but medical staff; they need the space to use the brains they've trained during the years of very expensive education they've been given.

yes give them that by virtue of having a stable & predictable framework to work within.

Only great artists fare well in chaos.

[mudskipper]

Doctors love people who turn up with print outs from the web, 15 minutes on google equals a medical degree don't you know.

I appreciate that, but I think it's fair to say that a GP is unlikely to be up to date on the research on every patient's different condition, and, when the patient has gone to the trouble to find some mainstream research that they'd like to discuss, the GP could at least do the courtesy of explaining why she disagrees.

I think the problem is that you can find evidence to support just about any view, but in this case I was trying to find out what the reference range meant, and it's clear that 95% of people have a lower TSH than me. If she doesn't think that getting me to a place where 95% of people are may give me a chance of feeling better, I'd like to understand why. FWIW, if I was in the USA, my values would not be considered normal - they have a much lower upper limit. Things are rarely black and white, and they should be prepared to discuss stuff.