Last Wednesday there was an article in the Herald headlined “‘It’s been horrible’ – GPs hit by new IT system glitches”. GPs are tearing their hair out as apparently the new systems are malfunctioning. I was aware of the problems because one of the GPs in my local practice had told me about them. And I got a text from NHS Scotland warning me in advance of some “disruption to routine services during the transition period”. I wrote to the Herald.
Dear Sir,
I wasn’t surprised to read that General Practitioners’ IT systems have been “horrible”. They have been horrible for the last quarter of a century.
IT systems are technologies in search of a marketplace. We need to recognise them for what they are, a money-making exercise in pursuit of the acquisition of power. In General Practice, the computer is the third party in the room, a threat to the sanctity of the medical consultation. In the modern jargon, they are not “value added”.
When I was in practice, I was never so happy as when the computers crashed. It meant I could get on with my work. All you need is a room, two chairs, an examination couch, and some peace and quiet.
The medical record might as well be in pen and ink in an A4 folder. And besides, the patient in front of me is not the same person as the one I saw a month ago. All medicine is acute.
But unfortunately, with the advent of artificial intelligence, it is only going to get worse. Have you heard of “ambient voice scribes”? They are in the room, these spectral apparitions, recording everything, whispering in the doctor’s ear that if you don’t follow the algorithms, you will be guilty of medical negligence.
Count me out. I would say to my erstwhile colleagues, simply log off.
Yours sincerely…
The Herald published me on Friday under the banner headline “Doctors beware: Time to log off from artificial intelligence”. I was hoping my letter might evoke some response, especially from the medical profession, so I was gratified to read a couple of letters from doctors in today’s Herald letters page. The first was positive and supportive, pointing out that General Practice is “an art based upon science”. I was reminded of the motto of the Royal College of General Practice – “Cum Scientia caritas”. My Cassell’s Latin dictionary translates caritas as affection, love, esteem. So the motto encapsulates the humanitarian aspect of medical practice, the amalgamation, if you will, of art and science. But Cassell’s also attributes another meaning to caritas – dearness, high price, and, apparently in Cicero, high price of the necessaries of life. The cost of living! If you were being mischievous, you might translate the college motto as “Technology comes at a price”.
The second letter from a doctor in the Herald wasn’t quite so supportive. I didn’t mind. Sometimes I think I have an unconscious, masochistic desire to be told to wake up and smell the coffee. “I was never happy when the IT systems crashed. Medico legally it was a nightmare.” I was then invited to come into the 21st century, and asked a direct question. “Are you equally happy when your banking App goes down and telephone banking suggests you try writing a cheque?”
I’m not sure if this is meant as a rhetorical question, but I’m minded to answer it. Yes, perfectly happy. As a matter of fact I write cheques quite often. I believe they are very scam-proof. I’m glad the correspondent brought in the banks, because they are the prototype of organisations that have become super-dependent upon IT systems. If we use internet banking, we need to understand that the bank is requiring us, not only to be our own bank teller, but also to provide our own security. When we carry out a transaction, say to make a payment to a new recipient, we are bombarded with questions as to how sure we are about the recipient’s authenticity, and we may be required to jump through certain hoops involving, say, a card reader, or a digital code sent to our mobile. Now we have become employed, not only as a teller, but also as a custodian of the vaults. But we’re not on the pay roll. We do it for nothing.
With respect to telephone banking, my bank recently tried to persuade me to adopt voice recognition as state-of-the-art security. I declined. You see, Boris Johnson sent my cousin, who is a baker, a text to say that he made the best pies in Christendom, or words to that effect. Of course, it wasn’t Boris at all. AI has mastered and defeated voice recognition.
If the bank doesn’t need to employ a teller, or a security guard, it can close down a High Street branch. We need to ask ourselves who is benefiting from this arrangement. The answer is, a diminishing number of senior executives who want to create a perpetual motion machine, a money tree that runs itself.
But the Second Law of Thermodynamics tells us that there is no such thing as a perpetual motion machine and that, fundamentally, is why these systems keep breaking down. The idea that you can organise life by negotiating a series of algorithms is flawed, tragically flawed. Life just isn’t like that. Human life is all about people, interactions between people, and communities. That, I think, is the lesson we have to learn during the 21st century, if we want to survive.
So I’m considering writing back into the Herald, with a digest of the above. I don’t often pen rejoinders to rejoinders; it smacks too much of “tit for tat”. Point scoring. Perhaps a dignified silence is better. And besides, I and the doctor who is inviting me into the 21st century actually share quite a lot of common ground. He is very keen on keeping an accurate medical record. Hear hear. Finding common ground is another very important lesson we need to learn.
I’ll think about it.
jamescalumcampbell 