As of Monday 4th of December 2023 our local surgery is changing how we access appointments and advice. They tell us that we will become a digital triage based appointment system which involves a new online consultation system which allows you to complete a short online form about your symptoms or concerns which will be triaged by a clinician.

So far so good. I had a look at the current website and based on what I can see so far, we are heading for an interesting time. Fingers crossed.

I’m going to interrupt myself at this point. Someone called me and used the term ‘hanging fire’. I immediately recognized it as one of these many terms we use without really understanding what we are saying. So, to ‘hang fire’ is

to delay, hesitate or hold back and dates in this figurative sense from the late 18th/ early 19th century. Before this, it goes back to the early 16th century and the days of the flint lock firearms where a hanging fire was the smoldering of the powder in the firing pan. This could happen when the powder was damp. In these circumstances, the rifleman or artillery man would certainly hesitate and there would be a delay because he could not be sure if the weapon would discharge or not

So, with that out of the way, we can proceed.

I remember when I first met the world of computers. It was 1974 when I came into the possession of an IBM computer. It was a huge thing the size of a filing cabinet which basically did the same job as a mobile phone does now. The details are hazy but it did a lot of clunking, clicking, and took a long time to react and not infrequently broke down.

I founded and ran an organization called London Village from 1970 to 1977. Apart from Dateline which was a computer dating agency that wasn’t much to choose apart from the inter Varsity Club and one or two other niche organizations so when I got the idea of London Village it was – unbeknown to me – an idea that had reached its time. The idear was that newcomers to London would be able to achieve an instant social life avoiding the tedious and drawn out process of getting to know people in one’s own area.

London Village was  one of the first to use computers to print out lists of people with similar interests, people who lived in a certain area for example London SW1 and W1 formed a group, NW1 and NW3 formed the Camden and Hampstead group. Once a month I went along to an office in Ealing with the new application forms and these were converted to punched cards which were then fed through a very impressive computer to churn out lists, printouts to order and address labels for our monthly mail outs.

Punched card sorter

I used a primitive PC when I worked for Church Action with the Unemployed which was situated in Bethnal Green in the east of London. I started being a serious end user after the events of 9/11 and now spend an indecent amount time researching the internet, adding data, producing databases for the use of the public and of course this diary.

The average person, if there is such a thing, does not necessarily and has not in the past necessarily had much to do with computers apart from writing emails and doing searching on the internet and maybe watching the odd video. They don’t have the feel for how it is to be used and particularly not being frightened of technology. I have noticed that most people fall into this category. ‘Oh, I don’t like computers, I don’t even have a mobile phone’

Cyberphobia is an extreme fear of computers. People with this anxiety disorder may also fear smartphones and the internet. Severe cyberphobia can cause people to avoid going to work, school or any place where there might be a computer. Therapy and technological education can help people manage symptoms of cyberphobia.

People are afraid of destroying all their work by pressing the wrong button. This is the cohort that is being asked to change their habits from the traditional wait on the phone at 8am for recorded messages saying you are number 26 in the queue. The letter we originally received from which I quoted, said that people can still telephone the surgery and a form will be completed on your behalf by our reception team and be added to the system in the same way as if you had completed it online, providing equal access for everyone.

For equal access, substitute the term ‘ trying to make it appear that people have equal access’. We know from the letter that 5 simple questions will be asked. Really? Here is a simple question ‘what is wrong with you?’, ‘ why do I have a headache’, ‘why do I feel depressed?’, ‘ how long has this been going on?’ You can make the questions as simple as you like but if the situation behind it is complicated then you won’t get much further along the line. I do so understand and sympathize with  the idea. The doctors only want to see people who will really benefit from a personal consultation.

However, what about the cohort who is of an age when you don’t want to bother people, and the issue that you want to raise is personal. Anything to do with ‘ down there’ referring to the intimate parts of ones anatomy I’m not sure whether people are going to be willing or articulate enough to mention this in writing. Can five simple questions be sufficient to determine what sort of treatment a person needs if indeed they need treatment at all. At a face-to-face interview or even a telephone call about something trivial, a doctor may pick up from the tone of someone’s voice that they are lonely and distressed. The doctor might recommend another form of treatment apart from perhaps a pill. How is the clinician going to pick this up from a form?

The basic rule in my book is that you write as if to a 12 year old. Explain, simplify and slim it down, then publish.

I have not yet seen the final draft of the second letter that will arrive slightly before the opening date I imagine. I hope that it will give a clear link to the actual appointment request page and not mixed up with a load of other categories.

It is a common failing of those who design software and internet sites that to them, who know what needs to be done, can see the entry point straight away so it’s hardly worse pointing it out,  but if you are new to the topic and you don’t know one end of a website from another, you need to be guided.

This is not an indication of lack of intelligence, rather a lack of familiarity. When you buy a new car, the sales person will sit with you in the car and explain the controls. That is done because you are unfamiliar with the layout of the dashboard and controls on the car. This applies to any new technology, real or virtual. I hope that this morning’s demonstration in the surgery will be sufficient.

One thing I suggest is an explanatory video done by a doctor or senior clinician Please, not a junior.

One pointer to the difficulties that people will experience was an elderly  woman this morning who had rather poor eyesight and was deaf.  She said to the instructor for the morning, ‘would you mind please speaking a bit slower’. He nodded but carried on at his normal rate. He was friendly enough though and really trying to communicate, but perhaps he did not have enough experience in dealing with hard of hearing people.

The session I attended this morning started at the page of the website relevant to the five questions. I would like to have seen a step further back where you could start with the new web page and follow – hopefully  – a clearly delineated link.

The current main menu gives the following categories: Home, appointments, contact us, covid-19 policies and procedure, practice information, practice team, prescriptions, PATCHS, online services, services, support your surgery, well being and health directory, women’s health, work with us, our surgery merge FAQ, who do I see?, flu and covid-19 vaccinations 2023.

Then in big letters – Exciting news (about the changes in December)

First off this is far too long and cumbersome for a main menu and will confuse and overwhelm people. It is not my business but I think the whole thing could be simplified much more. People go into a panic easily and become paralyzed.

This is a prime example of where cooperation is paramount between the practice itself, the people who are bringing in the new regulations which I presume is a national effort and the people who do the web development.

I can only hope and pray that everything will go smoothly.

So end this edition with some magic to gladden your heart.