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Health systems in 2020!
- Dr. Naseem A. Qureshi, MD, IMAPA, LMIPS (20 May 2004)
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Education for All
- susanne McCabe (21 May 2004)
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Dr. Naseem A. Qureshi, MD, IMAPA, LMIPS, Medical Director [A], Director, CME&R Postcode 2292, Buraidah Mental Health Hospital, Saudi Arabia
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Sir: The article by Coiera (2004) is certainly educational in nature but it is not debatable at all. By and large, there are historical close bonds between techn(ologi)ical developments and society leading to three broad concepts, i.e., technical systems, societal (or social) systems and sociotechnical systems. There are many illustrations of such inseparable, interdependent linkages between society and technology; invention of plane to rapidly cover long distances by people; invention of nuclear energy to supply electricity for multiple purposes to all people; and invention of nuclear bombs for the purpose of deterrance and so on. The main philosophical ideas behind such technolgical advancements are rapidity, cost-effectivity, accessibility, improvements over the conventionality, and all this for the tremendous benefits of the society globally. In particular relation to health informatics and for reinventing ehealth, Coiera has laid down four important rules with discreet accompanied illustrations that everyone of us should know by heart; technical systems have social consequences; social systems have technical consequences; we don't design technology [but] we design sociotechnical systems; and lastly to design sociotechnical systems, we must understand how people and technologies interact. Accordingly, sociotechnical systems consist of people, tools and conversation. Notably, social and technical systems in relation to ehealth can't work independently. In 2020, the medical profession will be decentralized and nearly deprofessionalized. The majority of epatients whose number would multiply tremendously will look after themselves with the help of e-communications and their quasi-medical colleagues. The epatients will spend less dollars on their health and at the same time live a better quality of life. They will have instant access to different types of medical information for allaying their multiple health concerns. As a corollary, there would be considerable patients load reduction on the ever busy physicians. Medical education and research would flourish globally. Finally, this paper is highly informative of fundamentals underlying health informatics development. Reference: Enrico Coiera. Four rules for the reinvention of health care BMJ 2004; 328: 1197-1199. Competing interests: None declared |
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susanne McCabe, retired cardiff cf 24 3pf
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There is a very long way to go yet - and many of us won't be around to see much of what is proposed as likely to happen in the future. Realistic steps of all kinds must be taken to involve people in running services, such as those being developed by Peter Elwood (Professor, Dept. Epidemiology, University of Wales College of Medicine).He demonstrates his committment to involving the public in discussions and decision making by setting up Public Lectures with invited speakers such as James Le Fanu (GP, Author),who gave a talk which seemed to worry the cohort of doctors who turned up with his questioning of some of the claims medicine makes to improving the health of societies, but which non-medical members of the audience found very interesting and useful. As was the talk on Risk by Liam Donaldson (DoH), who pointed out the high number of deaths which could be avoided with better designed equipment and protocols. This was especially relevant because there were two high profile cases against doctors going through the courts in Cardiff that week. The one demonstrated the high risk associated with a piece of anaesthetic equipment. This could it seems be designed to be almost error proof but a mix up with tubes led to the death of a baby. In fact the media did show how this could happen but inevitably concentrated on the human tragedy. The public had a great deal of sympathy in this case but the second highlights another point raised by Liam Donaldson, that we need to tackle the compensation culture relating to faults in the NHS. The public is not at all sympathetic to the doctors involved in this case because of alleged cover ups highlighted by the parents in the media and collusion by several agencies involved subsequent to the death of their young son. People are able to differentiate between different cases involving risk, include factors such as honesty and openess in their judgements about negligence and are usually extremely compassionate towards those who are genuinely sorry for mistakes - nobody is infallible - but the collusion culture as well as the compensation culture leads inevitably and justly to the courts. Competing interests: None declared |
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