Partha Kar: Technology and the NHS—a world of false promises?BMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l6135 (Published 05 November 2019) Cite this as: BMJ 2019;367:l6135
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I agree that we should "remember examples of how technology is skewed towards certain socioeconomic groups." and that we need to make sure that it does so for everyone, not just the digitally literate or the socioeconomically fortunate.
Patient access to record contractors are trying to take this into account as they produce patient health mangement tools - particularly pictorial tools for patients with low literacy.
Kessels (Kessels RPC. Patients' memory for medical information. J R Soc Med. 2003;96(5):219–222.) wrote: "When important decisions are to be made, the patient must receive detailed information on the illness, treatment options and prognosis. The shortening of hospital stays and the trend towards outpatient care enhance the need of patients and their families for specific information. Practitioners are responding to these demands, yet the amount of information correctly recalled by patients is strikingly small. In this review I examine empirical evidence concerning the obstacles to memory for medical information and offer some suggestions for overcoming them.
"Clearly, memory for medical information is a prerequisite for good adherence to recommended treatment. Ley's model on effective communication in medical practice stresses the importance of memory next to factors such as the understanding of information and satisfaction with the treatment. 40-80% of medical information provided by healthcare practitioners is forgotten immediately. The greater the amount of information presented, the lower the proportion correctly recalled;
"furthermore, almost half of the information that is remembered is incorrect. For the forgetting of information there are three basic types of explanation—first, factors related to the clinician, such as use of difficult medical terminology; second, the mode of information (e.g. spoken versus written); and, third, factors related to the patient, such as low education or specific expectations. Here, I discuss only the second and third, since the communication skills of clinicians have been thoroughly reviewed elsewhere."
"SPOKEN, WRITTEN OR NON-VERBAL?
"The form or mode of information is also highly relevant. In most instances, medical advice is spoken, but this is not a very successful method. Written information is better remembered and leads to better treatment adherence. However, written instructions do present difficulties to patients with low education or literacy and to non-native speakers, so other options have been investigated. For example, cartoons have been used to improve adherence to wound-care advice in patients just released from the emergency department: those who received the cartoon instructions displayed better compliance and answered more questions correctly.
"Patients with low education benefited more from the cartoon method than did patients with high education. Others have used pictographs— picture-writing—in cancer and HIV/AIDS. With spoken medical instructions only 14% of the information was remembered correctly, compared with over 80% when pictographs were used. Simple pictographs, with a clear and direct link between the picture and its meaning, are most effective. Further studies should focus on the clinical applicability of pictographs and their cost-benefit ratio."
Competing interests: No competing interests
Perhaps, I am not as pessimistic as Partha Kar. Yes , NHS is indeed a world of false promises in some aspects. Yes, it is clumsy and large and difficult to manage. Multiple hospitals under one umbrella. Referrals are not easy to accommodate and facing soared waiting lists. If you have a chronic illnesses than there you go, you already picked up the short straw and you need to get on with it. IT infrastructure has been an issue for many Trusts. We have a clumsy and thick headed Voice recognition (VR) software. It gives us a majority time headaches with picking up wrong words and making up non-sense waffles. Despite those shortcomings , NHS has been doing not to bad after introduced nationwide PACS __more than a decade ago__which allow all images stored electronically which is fascinating. After NHS x digitalisation of the NHS, I am very much hopeful to have some AI algorithms which would work for us with may be some technical hiccups and as we have been experiencing on VR application , we will eventually come round those handicaps. When it comes to research projects from the District General Hospitals (DGH’s ) I am afraid to say that situation not very bright in terms of funding and insufficient infrastructure, despite we have a reasonably motivated Research and Development (R&D) department. For that reason my self and colleagues opt to get involved “retrospective “ studies rather than “prospective” projects at the moment and we all look forward to get our magic AI algorithms and I feel they would be available in 5 years time. I am listening now AIVA ( Artificial intelligence Virtual Artist) Op, 24 “ I am AI” (1) with imagination of robust AI coming.
What will AI brings the medical sciences would be debated for a while__may be less than a decade__ emphasising the pros and cons.
I am hoping AI will be a close alley arising from the horizon (2) and a friend not a foe (3) for benefiting patients and doctors.
Keep the spirits up!
1. Op, 24 “ I am AI” AIVA. https://youtu.be/ju0fFWk3_dE ( accessed 09.11.2019)
2. Pakdemirli E. New subspecialty or close ally emerging on the radiology horizon: Artificial Intelligence. Acta Radiol Open. 2019 Mar; 8(3).
3.Pakdemirli E. Artificial intelligence in radiology: friend or foe? Where are we now and where are we heading? Acta Radiol Open. 2019 Feb; 8(2): 1-5. https://dx.doi.org/10.1177/2F2058460119830222.
Competing interests: No competing interests