Always Changing
Nov 08, 2023, 01:11 PM
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Dr Lloyd describes how digital technology has significantly impacted how GPs and patients interact:
Lloyd
I think that's I think that's what I would like to do. First get it out of the way in the instance is tell you about things that I saw changing. Within my practise, and I say I, joined as a fifth partner. But by the time I left I. Think there were eight partners altogether? We had no practise nurse. We had four people at reception by the time I left, there were two or three practise nurses and dietician. Goodness, there's what and it changed. The cause of taking on additional… some initiatives, you know, we broadened what we did from just doing. Morning and evening surgery and visits. To a much wider range of things. And that is very enjoyable in some ways, but of course it meant you were using up time and resources. Doing things which perhaps you had initially intended to do.
When it started, we had five minutes consultation times Mad, it seems mad. But then people came in just to have their blood pressure checked, or to have their injection. And they're being allowed in 2 minutes, so wasn't ideal. Of course, consultation times, lengths and. When I started, it was not unusual to do 10-15 visits. By the time I finished, we weren't doing anything like that. When I started, you had on call for 24 hours every week. And I remember. One of my registrars set a record of getting 10 night visits after the time of 10 o'clock. That's a lot, isn't it? You wouldn’t do 10 visits during the day now. And I mean, I say it was glad when we didn't have to do them. Anymore, but on. The other hand, I think in a sense that change made a massive impact on general practice. Because we had this move, well, we I'm not responsible for you all the time anymore.
There's, I think the sense of continuity they had when you were on call. You weren't personally on call, but the team was there all the time. Yeah. You know, look at what my daughter does now and she does some traditional general practice, but she also works for 111 and out of hours and things like that and. Its uh more a sort of portfolio then a single job to do.
So anyway come guess what other things changed. I mean also the thing about being on call you Know you, you used uh your telephone number, you’d ring up and say yes I come and visit you now. And then that phone number would be rung by my wife. Say, could you tell Doctor Lloyd he's got another visit because you know when he had a bleep. And wow, that was amazing, they could actually contact you. It doesn't always work. And then you got this old mobile phone, right? This massive thing that didn't, terrible reception in some areas. But then, because once you finally got phones that work that made a huge difference. It made it easier in some ways, but also of course you were that much more available. So you couldn't sort of say, well, I can't speak to you just now because you can, you're there, get on with it.
So I think that they like many innovations, they have their Advantages and disadvantages. We had a people switching system, it wasn't a system, it was just people have sent in little scraps of paper and the senior receptionist would write out, hand write prescriptions. And then we would sign them after we finished morning surgery. Wow. We actually introduced the card system where people have all their medication listed on a card. And when it was next due and things like. And then. I met up with a guy who is his brother to one of my fellow trainees in Taunton and he was from Ireland, he said. oh, Huw, I don't whether be interested in trying out this computerised repeat prescription system I've got for you and he came with this old I don’t think it's a laptop. It was not an eormous computer, but We started to computerise our peer prescriptions.
Interviewer
Can you remember by when that was?
Lloyd
Let me think. I was supposed to probably be in. Certainly after I came back from Australia but never early 90s, I think probably.
Interviewer
Yes, that's when we started out. That's works for me. Just wondered to give people an idea. interesting, yeah.
Lloyd
Yeah. About then. And that was the first step towards computerization and of course. Computerization started to evolve. General Medical records. And before that, we had the old Lloyd George. And we thought about going to af, but actually isation overtook that thank goodness because it was a massive change. The fact that you had things on call, you could pick notes up from your desk was excellent. But then of course, it did mean that everybody had to be very careful about making entries and I'm not sure every time all the entries were made that should have been.
And I none of the part of my, I'm digressing a bit. Let's stick with computers and what they do. Again, It was, it was good because you could bring up results so very easily. But it was only partial. It's not like the computer systems that I see in operation now. So there's always various limitations to them, always worried what would go wrong and how might it work if it crashed, which it did the times. Probably still does, I don't know, but one thing happens. [cough] excuse me
Interviewer
That's alright.
Lloyd
Yes. And then other things was things like the fact that people could take their own blood pressure. You know that made a big difference because they could monitor themselves. People start to test their blood sugars at home and and would monitor that more regularly. So there's more devolved the patient. I mean, when when I started, you know, people would look to me and say what should I do, doctor? And I had great difficulty with some patients to make them realise that perhaps they would be part of that decision making process.
Lloyd
I think that's I think that's what I would like to do. First get it out of the way in the instance is tell you about things that I saw changing. Within my practise, and I say I, joined as a fifth partner. But by the time I left I. Think there were eight partners altogether? We had no practise nurse. We had four people at reception by the time I left, there were two or three practise nurses and dietician. Goodness, there's what and it changed. The cause of taking on additional… some initiatives, you know, we broadened what we did from just doing. Morning and evening surgery and visits. To a much wider range of things. And that is very enjoyable in some ways, but of course it meant you were using up time and resources. Doing things which perhaps you had initially intended to do.
When it started, we had five minutes consultation times Mad, it seems mad. But then people came in just to have their blood pressure checked, or to have their injection. And they're being allowed in 2 minutes, so wasn't ideal. Of course, consultation times, lengths and. When I started, it was not unusual to do 10-15 visits. By the time I finished, we weren't doing anything like that. When I started, you had on call for 24 hours every week. And I remember. One of my registrars set a record of getting 10 night visits after the time of 10 o'clock. That's a lot, isn't it? You wouldn’t do 10 visits during the day now. And I mean, I say it was glad when we didn't have to do them. Anymore, but on. The other hand, I think in a sense that change made a massive impact on general practice. Because we had this move, well, we I'm not responsible for you all the time anymore.
There's, I think the sense of continuity they had when you were on call. You weren't personally on call, but the team was there all the time. Yeah. You know, look at what my daughter does now and she does some traditional general practice, but she also works for 111 and out of hours and things like that and. Its uh more a sort of portfolio then a single job to do.
So anyway come guess what other things changed. I mean also the thing about being on call you Know you, you used uh your telephone number, you’d ring up and say yes I come and visit you now. And then that phone number would be rung by my wife. Say, could you tell Doctor Lloyd he's got another visit because you know when he had a bleep. And wow, that was amazing, they could actually contact you. It doesn't always work. And then you got this old mobile phone, right? This massive thing that didn't, terrible reception in some areas. But then, because once you finally got phones that work that made a huge difference. It made it easier in some ways, but also of course you were that much more available. So you couldn't sort of say, well, I can't speak to you just now because you can, you're there, get on with it.
So I think that they like many innovations, they have their Advantages and disadvantages. We had a people switching system, it wasn't a system, it was just people have sent in little scraps of paper and the senior receptionist would write out, hand write prescriptions. And then we would sign them after we finished morning surgery. Wow. We actually introduced the card system where people have all their medication listed on a card. And when it was next due and things like. And then. I met up with a guy who is his brother to one of my fellow trainees in Taunton and he was from Ireland, he said. oh, Huw, I don't whether be interested in trying out this computerised repeat prescription system I've got for you and he came with this old I don’t think it's a laptop. It was not an eormous computer, but We started to computerise our peer prescriptions.
Interviewer
Can you remember by when that was?
Lloyd
Let me think. I was supposed to probably be in. Certainly after I came back from Australia but never early 90s, I think probably.
Interviewer
Yes, that's when we started out. That's works for me. Just wondered to give people an idea. interesting, yeah.
Lloyd
Yeah. About then. And that was the first step towards computerization and of course. Computerization started to evolve. General Medical records. And before that, we had the old Lloyd George. And we thought about going to af, but actually isation overtook that thank goodness because it was a massive change. The fact that you had things on call, you could pick notes up from your desk was excellent. But then of course, it did mean that everybody had to be very careful about making entries and I'm not sure every time all the entries were made that should have been.
And I none of the part of my, I'm digressing a bit. Let's stick with computers and what they do. Again, It was, it was good because you could bring up results so very easily. But it was only partial. It's not like the computer systems that I see in operation now. So there's always various limitations to them, always worried what would go wrong and how might it work if it crashed, which it did the times. Probably still does, I don't know, but one thing happens. [cough] excuse me
Interviewer
That's alright.
Lloyd
Yes. And then other things was things like the fact that people could take their own blood pressure. You know that made a big difference because they could monitor themselves. People start to test their blood sugars at home and and would monitor that more regularly. So there's more devolved the patient. I mean, when when I started, you know, people would look to me and say what should I do, doctor? And I had great difficulty with some patients to make them realise that perhaps they would be part of that decision making process.