Tuesday, 22 June 2010

Telehealth, & Jargon

Sometimes as you do a little research for a post you find you have hit a rich seam of material, full of new information, and unexpected connections. When I recently stumbled onto this document I did not at first see it as much more than the basis for a rant about management doublespeak and obfuscation. Persevering through the almost incomprehensible paragraphs I started to understand what it was about. And the more I read the more angry I got.

First of course it is, superficially, a prime example of management jargon. Phrases like “thought leadership, capacity building and system regulation to the NHS..........consistent with delivery of the work programme of the Long Term Conditions Healthy Ambitions Pathway and securing the regional element of the QIPP strategy. say it all. The document goes on (and on and on) in similar vein. Einstein once said “If you can’t explain it simply you don’t know it well enough” So the author, one Professor Sue Proctor either does not know what she is talking about, or, more likely, she is trying to dress up and obscure something unsavoury.

Telehealth is supposedly a concept of delivering health care without the troublesome business of doctors actually having to see their patients in the flesh. Instead patients would have “telemonitoring, video consultations, and teleeducation”. I think most clinicians can see the flaws with this but Prof Proctor does not, though she does acknowledge the risk that, from Strategic Health Authorities down to individual clinicians there may be a lack of enthusiasm. This does not seem to deter Ms Proctor who enthuses “This is an ever developing market sector with a range of commercial providers and NHS/Foundation Trusts likely to be attracted to a business opportunity of this magnitude.”

I am deeply repelled by this idea that the NHS has come to be regarded as a “business opportunity”, a means for some to make disproportionate profit in a manner far removed from taking an honest days pay for an honest days work.

Ms Proctor also cites proof of concept from Airedale Hospital of all places, which has recently been highlighted for serious failings, leading to police involvement. Further the “workstrand” is being led by none other than Adam Cairnes, the very individual responsible for those failings, whilst CE at Airedale.

So who is Prof Susan Proctor? Her qualifications are listed as RGN, MSc PhD. That’s right, she is a nurse, removed from the one area where she might be of some use, nursing. Looking at her previous positions and relative youth it seems pretty unlikely that she has done much actual nursing.

I have the greatest of respect for my nursing colleagues, but I think the interests of patients are best served when nurses actually nurse. I believe that nursing is primarily a practical, and not an academic subject and that the change of nursing to a degree course was detrimental to the profession. I know many nurses who agree with me.

It seems to me that Ms Proctor has used nursing as nothing more than a vehicle to attain for herself a position far far beyond her intellectual capabilities, where she feels she is qualified to pontificate on how to deliver medical care.

Telehealth is in my view an abomination. It is the ultimate separation and alienation of patient from doctor. Those who advocate it seem to understand nothing about the doctor patient relationship and the importance of proximity in a consultation. The ability to physically examine patients, to make eye contact and to be able to shake or take the hand (without gloves!). As Jacob Bronowski once said “We have to touch people”


  1. Dear me Doc, are you Dr. Crippen in disguise?
    You have an absolutely valid point about telemedicine, telehealth(whatever that is) and documents full of jargon and then go on to spoil it with one paragraph. Although I agree totally with the first sentence.

    "I have the greatest of respect for my nursing colleagues, but I think the interests of patients are best served when nurses actually nurse. I believe that nursing is primarily a practical, and not an academic subject and that the change of nursing to a degree course was detrimental to the profession. I know many nurses who agree with me.

    Nursing was a practical subject back when I trained but it is not now, hospitals and patients require well educated nurses who can understand what is actually happening around them and more importantly how to react to it.
    If you know nurses who agree with you I would be inclined to believe that they are either old nurses hankering for the 'good old days' or nurses who for some reason do not want to earn a degree.
    In my health area every nursing job which is advertised states as a condition of service - 'Must have or be working towards a degree.'

  2. No, I am definitely not Dr Crippen. Not fit to wear his shoes.
    Are you saying that degree nurses are in some way better than their pre degree colleagues, who were in some way inadequately educated? That is not my perception, though I am not saying they are worse either. I do recall a study some years ago, commented on by Peter Hambley in "Hospital Doctor", suggesting a very poor level of intelligence and understanding in post degree nurses. Dr Hambley was apparently castigated by his employers for the article, which is a shame. The right to offend, within the law, is crucial to our free speech.

  3. Back when I was a boy and this was all fields, night out for 10 Shillings etc. etc........

    Sorry. Nurse training when I trained consisted of rote learning what was put in front of you, you were certainly not allowed to question the lecturers. As we were employees they had a huge amount of control over us. If you learned what you were told you would pass exams. Now in degree training, nursing students are expected to find out for themselves, to question everything and ask the question, Why?
    So educationally, yes the degree nurses are better. As for practically? I am of the generation now that looks at what we do and complains bitterly about the paperwork that has to be completed to prove you have done what you have said you have done. I used to write on patients charts "All care given" and that was enough. We all tend to think that the training we received was best and 'this modern' training is rubbish. Not helped by headlines from the Daily Mail. When I qualified there were more nurses (Staff Nurses, Enrolled Nurses, STudents and HCA's) on the wards and the patients were not as sick as they are nowadays. I find modern students just the same as they have always been, some are excellent and some are rubbish and most are in-between. This extends to qualified nurses as well.

    Hospital Doctor is a newsy type magazine similar to The Nursing Times. Neither should be taken seriously. Peter Hambley is a satirist and is again not meant to be taken seriously. I am unable to obtain access to the article you mention but if he had evidence then I am sure he would have published it.

    I agree that freedom of speech is paramount.

    If you have read Dr. Crippens stuff then you will appreciate that I do not want to go down this route again, I get fed up arguing the same things over and over.

  4. I am a Project 2000 nurse (qualifying in 1993) and do worry about the Degree v Pre Degree war that nurses have declared on themselves. At a time when wards are chronically and dangerously understaffed, it seems to me that this curious infighting is injurous to us all.

    I am not degree educated - but this does not make me stupid and I am certain that this also applies to Grumpy RN. As no doubt he has, I learn as I go along. I have learned more since qualifying than I learned in my three years of training and continue to educate myself and will do so for ever more. If I lack knowledge in a certain area - I will ask (for not to do so is dangerous) and this does not cause me embarrassment.

    In my own working environment I have responsibily and accountabily for four staff and forty-four patients. I liase with other health professionals. I do it well and thoroughly enjoy it.

    I think whether I am degree educated or not is irrelevant. In 'both camps' I know nurses who are utterly brilliant, utterly borderline dangerous and also those who are utterly complacent and think they 'know enough'.

    I follow MMN and despite some of her views that I disagree with (the Degree v Pre Degree argument), I admire her immensely. As a degree nurse she continualy points out that she doe not have time to nurse due to other constraints on her time. It is obvious that whether a degree nurse or not, every nurse who entered nursing for the right reasons actually wants to nurse!

    The above aside - I totally agree that the concept of telehealth is an abomination.