Joe’s view: of emailing patients

It must be 15 years ago. Steve and I waited nervously in the car on the outskirts of Izmir, Turkey.

We had been speeding north in a hurry to get to a photoshoot that required us to be in a vineyard at dawn as the first rays of the sun hit the ripe grapes that were destined to be Whitworths Sultanas.

We heard the siren and then saw the flashing lights filling the rear windscreen. Neither of us knew the protocol for being pulled over by the Turkish police; but we knew that the police are routinely armed so we both instinctively put our hands on the dashboard.

The policeman smiled and asked for our passports. We showed them to him. He pointed at the speedometer and wagged his finger at us.

He wrote “80” on a piece of paper, crossed it out, wrote “95” on it, and pointed at us. We had been doing 95 in an 80 zone. So15km/h faster than the limit.

Now he wrote “15 X 10=150L”. Our fine was 150 Turkish Lira (about £40). We paid, he gave us a receipt, and we went on our way carefully observing the speed limit.

The golden time

When we arrived at the vineyard we had missed “golden time”. Steve was a very successful professional photographer and friend of mine.

Whitworths was re-branding and had hired Steve to capture the gorgeousness of Whitworths Sultanas. As his usual bag carrier was unavailable, and I was already in Turkey, I opted to be his assistant on the shoot.

My hope was that I’d learn to take better photographs in the process. The first thing I learned was about what Steve called “Golden Time”. Golden time is the 15 minutes just after dawn and just before sunset when the earth is bathed in a golden light.

Everything and everyone is beautiful. I carried the bag with thousands of pounds worth of giant cameras, tripods and special film. I also carried a little spray to simulate dew on the ripening grapes.

Steve took a dozen carefully framed shots – film is expensive. The results were stunning and Whitworths were very happy with them.

It was great to see “our” handiwork on the packets in supermarkets. Neither of us realised that this shoot was almost the end of an era, the end of golden time for professional photography.

Online libraries of stock photos and advances in digital photography put an end to the commercial requirement for people like Steve, who make art by flying half way round the world to paint with light at the perfect moment.

Now if you want a nice photo of grapes at dawn you just Google it. As Steve said “any damned fool can take great photographs now, and if you can’t you can fix it in Photoshop.”

The only time people want a proper photographer now is when they get married. Steve is still painting in light, but mostly at weddings.

Seventy nine million pounds (and counting)

I have been waiting for a similar end to golden time for postage stamps for some time now. And yet my trust’s postage bill remains stubbornly high. In fact, it significantly increased when we brought in the policy of copying letters to patients.

It’s difficult to find out the NHS annual expenditure, but a 2012 report put it at seventy nine million pounds per year for England. That’s £79 million straight down the toilet, every year.

Enquiries locally suggest it may be much more than this and, remember, that bill is just postage – not paper or typing or printer cartridges.

This waste goes on while the vast majority of people have email or other messaging options. The NHS is probably the only organisation in the world that does not routinely collect its customers’ email addresses and use them to cut the cost of communicating with them.

I had an interesting exchange on this subject on Twitter the other night. I follow the Office of the National Coordinator (since our health secretary became such a big fan of all things American, it has seemed wise to keep up with thinking in the States).

One of its tweets led me to this interesting video. The fictional patient is entirely in charge of how her record is shared, and that includes the option of having her doctor email the whole thing over the internet to her own email account.

The doctor warns the patient that not all email is secure; but the patient opts to ignore that warning in favour of having possession of her own record when she moves to another city.

In the Twitter debate that followed one American observed: “Yes, in the US, we do not tell private grown-ups how to store or transport their health data.”

Elsewhere in the debate, people I trust say that email is unacceptably risky. However, it’s not in my opinion as risky as second class post.

When we make a mistake addressing your letter from the sexually transmitted diseases clinic, the security of the low quality brown envelope is more likely to be breached by your spouse or a neighbour than if we get your email address wrong by one keystroke.

So even if we are nervous of sending information by email, could we at least mail or message our patients to say: “Take a look in your NHS account – there’s a message for you”?

If there’s some money about, this would be a good use for it

Could we at least set up such an account for those citizens who are willing to move away from the brown envelope? Maybe for £79 million pounds a year we could.

This might be a job for our ‘global digital centres of excellence’. Maybe they can call an end to golden time for the postage stamp.

If they could do that much, then the whole NHS would benefit from the £100 million investment to be given to the cream of the CDMI / DMA crop.