The ability to store patient records on a handheld computer is perhaps the feature that clinicians want the most, yet it also is perhaps the hardest to provide. If you are buying a device for yourself simply so that you can use it for medical records, then you should abandon the purchase and save your money.
Let us explain why we say this. It is relatively easy to store information about your patients in your personal database. Buy HanDBase, create your forms and start entering patient data. The difficulty comes when you have to share information with other clinicians. Beaming may be enough for small teams, but for any more than five clinicians, you will need to synchronize your devices with a central computer… and that requires the help and support of the IT department.
The practice of medicine means that you almost always have to share information with your colleagues. Whether you do it in the paper notes or your institution’s electronic medical records system, you must document what you do to the patients so your team can provide appropriate care.
Thus, if you decide that you do not want to share the patient notes on your device because of the complexity of involving the IT department, you will have to duplicate your writing: once for your device and again for the institution’s notes. You will soon get tired of this; we are all too busy to be duplicating work.
On the other hand, in institutions around the world, and increasingly with the support of national governments, IT departments are switching to electronic medical records. In many cases, handheld computers are part of that switch—or at least they are planned as the next stage. In such institutions, the doctors will be provided with handheld computers as part of good clinical care.
If you are in such an institution—congratulations, make use of your good fortune and enjoy your equipment!
If you are not, then you can change the institution and convince its decision makers of the investment, but this is a long process and requires sustained effort. In the meantime, do not buy a handheld computer for yourself in the hope that you will get the support for medical records software. It will not come soon.
Of course, you should still buy the device for all the other advantages, and we hope that we have convinced you of their value. The rest of this article will discuss the options you have as you move your institution to electronic medical records.
Medical records systems for small individuals and small teams
The easiest way to begin managing your patient’s records at the start is to buy software like Patient Tracker [www.patienttracker.com], which includes a handheld computer version and a PC version. This makes it easy to enter most of a patient’s information at your clinic desk but to add more details with the handheld computer at the patient’s home or to read those details on the device while away from your desk. The data are encrypted.
The software is designed for American clinicians and is ideal for small practices. It is not suitable for general practitioners in the UK, as more than 95% of their practices already have an electronic medical records system—and their complementary handheld computer versions are better. For doctors in hospitals in the UK that do not yet have a such a system, however, Patient Tracker could be a useful purchase for each small team.
If for any reason you do not like Patient Tracker’s interface, however, you cannot modify it. This is why so many clinicians like HanDBase: each team can create the exact forms they need for their workflow. The effort of designing and implementing the forms is not trivial though and will take some time for experimentation.
Whatever you decide, one risk to think about is losing data. You can consider buying a backup SD card for your handheld from companies like MDM [www.gomdm.com]—for around $50 (£29), the card allows a complete backup of your device. Should you lose the data for any reason, you can restore it within a few minutes after inserting the card into the device. More dangerous is losing the device itself through theft or forgetfulness. This is why encryption is so important.
Bespoke medical recrods systems
With the financial and managerial support of your institution, you can consider a medical records system tailored to your team’s needs. Scotland has wonderful examples of this, as the government has standardized data formats (which means that medical software designers can more easily share patient data between their products) and has provided budgets for software investments and target dates for implementation. Unlike the government in England, however, Scotland’s government has not been involved in micromanaging implementation.
This has led to many new companies creating innovative products and tailoring them to clinicians’ needs. For example, Extramed [www.extramed.co.uk] and Kelvin Connect [www.kelvinconnect.com] both created software that allowed hospital clinicians to read information on their patients during the ward round. The information is synchronized automatically between the handheld computer on the ward round, the PCs of the nurses in the medical assessment unit and the workstations of the radiologists in their offices.
What is interesting about these examples is the new working habits that they support and the planning that the team must go through. For example, in Lanarkshire, the software is a small part of the innovation of the night time hospital emergency care teams. A small team of two nurses and five doctors triages and treats the hospital’s inpatients overnight. In the morning, the nurses provide a report on each patient they treated, because it was the nurses that prescribed many of the drugs and the nurses that had the handheld computers.
For these habits, the doctors, nurses, managers and software developers worked together and decided on how to best to proceed for their patients. When you understand the information in this book, you will be one of the best people in your institution to help guide the decision-making for handheld computers. Find out about the committees involved in such planning and contribute to them.
Even if you cannot contribute to the design of a custom system for your team, you can still play an important role if your institution chooses an off-the-shelf medical records system. This is happening in England, where the government has designated specific medical records system providers for each region. Furthermore, in many institutions, including the practices of all general practitioners in England, complete medical records systems already exist. You will not be able to switch to a different provider, but you still can buy the handheld computer version of their software. For example Inchware [www.inchware.com] makes impressive PDA versions for the existing products of EMIS, iSoft, Torex and Vision in the UK, while IDX and McKesson in the USA also have had their own mobile software for several years.
Even after the purchasing decision has been made, and even if the product is fixed and not customized, you still will play a crucial role. For example, you can take part in the early testing. This will mean that you can advise on the rate of deployment—which wards should come first—and will be ideally placed to provide training for your colleagues.
Such work is good for your career. For many clinicians, such satisfying work has prompted a switch to medical informatics as a specialty. In the end, of course, it will be the patients that benefit. Medical errors are many, expensive and dangerous. To reduce these and improve care governments around the world are investing billions of dollars in solutions. Electronic medical records are a vital part of these, and handheld computers are already making their mark. We hope that these articles help you bring the benefits to your patients.
Clinical vignette of medical records
Impressed by the work of Dr Cochrane in her general practice surgery, Dr Snow bought a handheld computer. It greatly improved his organization, and they designed a database to store audit information about their patients with diabetes for audits.
Soon, their seven colleagues wanted to make the same investment. In a practice meeting, they decided that each doctor should buy their own device to suit their tastes. Because the practice had an EMIS medical records system, the clinicians with Palm Powered devices could use the EMIS PDA software, while those with Pocket PCs could get EMIScompatible PDA software from Inchware.
This allowed Dr Snow to take the records of the patients he would see on a home visit, refer to the prescriptions and past medical history while with the patient and make notes on the visit on the handheld computer. Once back in the practice, the new notes would synchronize back to the central computer and become available to the PCs and PDAs of the other doctors and nurses.
The software did not do everything the team required, however, so Dr Snow wrote a business case for the purchase of custom software to monitor the progress of patients with cardiological conditions and diabetes. He received funding from his primary care trust and found a small company in the area. They collaborated on the design of the software and made sure that it integrated into the existing EMIS system.
The product was so well suited to the management of the patients’ conditions that he was able to coauthor several papers that documented the improved control of hypertension, and several practices in the surrounding area also invested in the software.
By this time, Dr Snow was hooked on the benefits of handheld computer for good clinical practice. He started a long-distance course in medical informatics, supported by a scholarship from his primary care trust, and searched for other areas in which he could improve patient care.
This is the fifth in a series of extracts from a forthcoming book by M Al-Ubaydli and C Paton. The website [www.rsmpress.co.uk/bkpda.htm] includes video tutorials to accompany this text.
Citation: Paton C, Al-Ubaydli M. The Doctor’s PDA and Smartphone Handbook Medical records. J R Soc Med. 2006 Apr;99(4):183-4.
I want to echo the truth of what is written in this article. This will probably be a lengthy message and I hope you will indulge me. A New Orleans native (grew up in the 9th ward), I spent much of February this year back in my home of NOLA. First I visited with my father who is not well, and then volunteered at a week long free health fair sponsored by the NO City Dept. of Health and a group named Remote Access Medicine (which normally provides free medical care in remote third world countries- pretty much what New Orleans seems to be these days).
I found it difficult to believe what I saw. I am no stranger to the impoverished and sick. I’ve worked at Charity Hospital in NO and my dissertation field work was done in the city’s public housing projects. I’ve also worked in public health care in San Francisco, San Francisco General and Highland Hospital in Berkeley.
I have never seen so many desperately sick people in one place in my life while working at the health fair. Diabetics who hadn’t had insulin for months, asthmatics gasping, persons with untreated emphysema, persons with severe arthritis trying to support themselves by hanging over police barricades all standing in a daily line of 1000+ people (no
exaggeration)waiting to get inside the Audubon Zoo where free medical, dental, and ophthalmic services were being dispensed. People had been camping out, some since 3am, to get a place in line. Public transportation is very limited right now, so who knows how many people couldn’t get there?
There was the woman whose foot had swollen to at least twice its size because she had stepped on a nail trying to clear out her house and didn’t know where to go to be treated. She had been “hoping it would get better by itself.” A young man came in septic, barely able to stand with an abscessed tooth because he hadn’t been able to get care. Most of what we saw that week could have been easily preventable, and probably would have been minor injuries or illness episodes, if there had only been a readily available health care system for the people to access.
My job the first day was to “walk the line” of people waiting to be seen to determine who was near passing out and who need EMS. Many people did faint, the sick, the elderly, people who just couldn’t remain upright any more in the heat. At least one elderly woman was treated for head injuries and taken away (we weren’t certain to where) after fainting in
line. There was no water or food for the people the first day although it had been promised. A small group of us went and confiscated a very limited supply of water intended for the health workers, and found ourselves in the truly awful position of deciding who in the crowd needed it most.
Few of the illnesses we saw that week would not be as severe as they were if there had been an adequately functioning health care system or even emergency relief system in place. There is little health care available, the system is overtaxed, almost no one we saw had health insurance. These were not all chronically indigent persons. Most were employed or formerly employed persons. There were persons of all colors and ethnicities, all ages. I personally met with at least five schoolteachers, who had lost everything, including their jobs (few schools are open right now) and so lost their health insurance. They had
not been to a doctor in months despite chronic illnesses. Cancer patients not know where or how to get follow up treatment (if it was available). It goes without saying that mental health problems were (and are) the norm both among patients and New Orleans health providers.
Why? New Orleans is supposed to be a part of the U.S. It presently feels more like an abandoned colony. Most of these people are taxpayers. People repeatedly lamented that they felt abandoned by the government. I am a federal worker but volunteered as a private citizen. People asked me repeatedly, that when I got back to Washington, I let everyone know about them so that they wouldn’t be forgotten. The question was “how can they [the nation] forget us, don’t they understand what’s happening down here?” I ask myself this question constantly. My heart has broken just about daily since Katrina but never so much until I
was face to face with my fellow Orleanians’ unnecessary disease and suffering. We at the health fair didn’t even approach seeing everyone who needed services. The people of New Orleans are unnecessarily suffering and dying. I don’t think it has to be this way. The city (and in truth the whole region) desperately needs help. The floodwaters are gone, but Katrina is definitely not over. The disaster is still happening.
Thank you very much for reading this, and I hope it wasn’t too much of a rant. I’m having a difficult time coming to terms with what I experienced. Please don’t forget my hometown.
National Cancer Institute
I do not think that it has to be this way.
I do not like war, but some people do.
Certain sectors of the American economy do well from wars. Obviously the weapons manufacturers benefit, like Raytheon which got to test out and successfully market its Patriot missile system in the 1990 Gulf War.
But more interesting are other companies which make civilian technology but require the government military contracts to get start. In 2003 a lobbyist friend of mine in DC took me to the offices of a startup that began with voice recognition software. Their first real customer was the US government in Iraq.
That contract was for garbage collection. Apparently, garbage was not being collected, instead it was left to rot in some neighbourhoods. However, the US military was not very good at talking to Iraqi citizens so could not find out about the location and frequency of these problems. The company created a freephone hotline that allowed citizens to report the problem from their neighbourhoods to the software. The government then had a map of the problem hotspots.
I doubt that the garbage was collected in response – the reason that Iraqis were not talking to the Americans was the same reason that the garbage was not being collected, ie the areas were too dangerous to be seen cooperating with Americans. What Iraq needed was better engagement with and cooperation from American troops. But that is difficult and does not serve the American economy. Instead, giving a military contract to that startup contributed to the innovations and export products of the American economy and that is what happened.
Arms and military forces were pure burden and drain on the civilian economy and society for untol centuries[...] Then, in the seventeenth century, things changed drastically. For two hundred fifty years, through World War II, the defense economy and the civilian peactime economy moved in tandem, mutually enriching each other. The turning point was the Dutch invention in the late seventeenth century of the first ship capable of carrying a substantial cargo in addition to its crew and their provisions. This ship, a man-of-war originally designed to carry heavy guns, was soon converted into the world’s first efficient freight carrier. It was one of the greatest technological breakthroughs that peacetime economy ever experienced-as great a breakthrough as the steam egine or the computer or biotechnolog. It brought about the commercial revolution of the eighteenth centurey in which, for the first time in history, trade was worldwide. Europeans started their march toward economic penetration and dominationce of the entire globe. For two hundred fifty years almost every advance in military technology thus quickly provided new energy for the civilian economy. And civilian technolgy rapidly was applied to military technology. Military technology created the first modern roads, designed and built primarily for the attempt of Louis XIV of France to become master of the European continent in the early eighteenth century. They immediately became roads for inland trade. To provide the engineers to build the roads, the first technical university, the Ecole des Ponts et Chaussees, was founded (in 1747). With it emerged the profession of engineer and te systematic application of science and technology to the design and production of goods and services.
Conversely, every major innovation in the civilian economy during the two hundred fifty years afer 1700 found military application almost immediately: the steam engine, the telephone, the wireless, the automobile, the airplane. And wars, for all their destruction and waste, provided economic impetus for two hundred fifty years, greatly speeding up technical dvelopments that otherwise would have taken many decades to reach commercial application. The textbook example is Napoleon’s paying for the forced-draft development of beet sugar to break Great Brtain’s monopoloy on the supply of cane sugar to Europe; it is the first instance of “governmental defense research”.
But fo World War I, radio would probably not have been developed until thirty years later, that is, until the 1950s. Because of the poor performance of the field telepones during the battles of World War I, engineering talent and large uantities of government money were provided for the development of wireless transmission of voice and music. The computer might well have taken thirty or forty years loner but for World War II. The first working computer, the famous ENIAC, was built for military needs and with military money. The Cold War a few years later then gave IBM world leadership in computers. The military orders for “early warning systems” in the Canadian Arctic enabled IBM to design and manufacture the first working computers in substantial numbers.
Equally important: during the two hundred fifty years that began in the late seventeenth century, militar aid and civilian production facilities were interchangeable. Civilian production facilities and civilian products could easily be converted to wartime production and wartime use, and could then be reconverted almost immediately to peacetime use. A major reason for Britain’s surge into economic leadership in the early nineteenth century was its ability to convert the shipyards that hadbuilt Nelson’s fleet to building the newly designed packet boats and clipper ships that came to dominate oceangoing trade for the next fifty years. This also happened on the other side of the Atlantic in the shipyards that had been built during the American Revolution and expanded during the War of 1812 to build and American navy. When the United States entered World War II in December 1941, it had literally no war production capacity. It took less than four month, however, to convert a plant that had been assembling Buick, Oldsmobile, and Pontiac automobiles in Linden, New Jersey, into the largest producer of carrier-based fighter planes. And by January 1946, five months after World War II had ended, the plant was again producing Buicks, Oldmobiles, and Pontiacs.
The next paragraph begins “But now this is over” (his emphasis) but still this is a fascinating description of the advantages of war.
[P]eople used to say that in war there were no victors; victor and vanquished, all suffered alike. In the perspective of history we can see how untrue this was. Before nuclear fission arrived, war benefited everyone, especially the defeated countries – witness Russia, Germany, China. War stimulated inventions, and, even more important, war stimulated the betteruse of human resources. In the First World War the U.S. Army put two million recruits through intelligence test, so succesfully that practically armies adopted the same practice when they were mobilized on later occasions. In the Second World Ward the British Army again demonstraed the extraordinary effectiveness of psychological selection. These were in their time great achievements. War woke people up to the fact that the nation possessed a supply of ability never ordinarily use to the full. Every child from an elementary school who became an officer in the Hitler war – many as they were, once merit rather than parentage became the test – was an argument for educational reform. It was no accident that the three great education Acts of the first half-century, 1902, 1918, and 1944, were put on the statute book at the end of the three wars, nor that the cause of reform, in civil service and army alike, was in the previous century so strongly assisted by the Crimea.
I am fifty years behind the rest of the world, but I have finally discovered the joys of Peter Drucker’s books. The first book I read is “Innovation and Entrepreneurship”, from which I have been mulling on this insight from page 247 about Xerox and its invention of the photocopier:
One reason why patents on a copying machine ended up at a small, obscure company in Rochester, New York, then known as the Haloyd Company, rather than one of the big printing-machine manufacturers, was that none of the large established manufacturers saw any possibility of selling a copying machine. Their calculations showed that such a machine would have to sell for at least $4000. Nobody was going to pay such a sum for a copying machine when carbon paper cost practically nothing. Also, of course, to spend $4000 on a machine meant a capital-appropriations request, which had to go all the way up to the board of directors, accompanied by a calculation showing the return on investment, both of which seemed unimaginable for a gadget designed to help the secretary. The Haloid Company — the present Xerox — did a good deal of technical work to design the final machine. But its major contribution was in pricing. It did not sell the machine; it sold what the machine produced, copies. At five or ten cents a copy, there is no need for a capital-appropriations request. This is “petty-cash”, which the secretary can disburse without going upstairs. Pricing the Xerox machine at five cents a copy was the tru innovation.
It is wonderful to have something you have always felt be so beautifully expressed. The reason I liked handheld computers, and the reason I like open source software even more, is that these technologies are cheap enough at the start not to need a decision from upper management. While working as a doctor setting up a handheld computer project was easy – I just had to convince my clinical colleagues to buy their own machines, and we would work together. They were quick to agree because the cost of a device was low, and the benefit obvious. Rightly or wrongly, as doctors we were the equivalent of the secretaries, and saving their labours with handheld computers was not something management had interest nor ability to consider.
Open source software pushes the bar even lower. With any team that I work, I suggest that open source software may be useful, the direct beneficieries agree to give their time for the experiment, and we just get started. No appropriations request, no management deliberations, we just start. If things go well, we let management know of the early success and ask for institutional support. If not, we move on to the next experiment.
It is because of this decision-making process that proprietary software companies are caught off-guard by companies with open source software at the centre of their business model. Before they could concentrate their marketing efforts on convincing upper management that the expenditure is useful – the software did not have to be useful to the employees who ended up using it every day, but it had to have the right buzzwords that management would think it was a good solution. With open source software the end users are making the decision – and theirs is a much more intelligent and accountable process – and the marketing departments’ ovetures to upper management become expensive overheads rather than powerful assets.
We all benefit from this change is decision-making.
As I travelled to London last week I was delighted by this headline:
Accenture’s NHS losses grow as NPfIT delays mount: Accenture, the leading management and technology consulting firm, announced a provision for a further $450 million of losses against its contract to deploy IT systems on behalf of the English NHS. The provision led to a sharp drop in quarterly profits.
Not (necessarily) that I take pleasure in Accenture losing money, more that it the possibility of losing money or gaining profit does wonderful things to the running of projects. I am reminded of an excellent lecture “Fraud, bankruptcy, suicide and transportation: The history of the London Underground railway” by Dr Stephen Halliday. The link has the lecture’s transcript and video, and it is worth viewing, and the anecdotes are often hilarious. As the title suggests, the lecture is filled with stories of fraud, bankruptcy and suicide from the Victorian businessmen (and they were men) who built the London underground:
[W]ithout these kind foreigners and without people like Charles Tyson Yerkes, we would have no Underground Railway. I hope that by the time Iâ€™ve finished speaking, you will have come to the conclusion that Ken Livingston is a pussy cat compared with some of these!
The National Program for IT is making a lot of mistakes and the latest issue of UK Health Informatics Today is full of my criticisms of these mistakes, including an insufficiently fluid marketplace for the contracts. But, at least they do have private contractors for this enormous public sector big project. These private contractors can lose money, as Accenture and iSoft have found out, and that concentrates the mind beautifully. By contrast public sector managers who have overpromised, overspent and underdelivered remain in their jobs and their careers continue to progress.
Of course the other side of the coin, however, is that when the remaining contractors do start making money – and they will, handsomely so – the public will not begrudge them the money.
On Saturday in London I met Drs Peter Drury, Simon Fraser and Adesina Iluyemi to discuss using new cellular technology to serve electronic medical records to handheld computers in African countries. It was a useful discussion and my three colleagues were highly experienced in deploying projects in the developing world. Peter, who had originally called the meeting, has been helped formulate policy at the UK’s Department of Health, and is tailoring its Map of Medicine for Kenya.
Soon afterwards Adesina moved the discussion to the excellent HIF-net mailing list. And then Holly Ladd, Executive Director of the pioneering SATELLIFE team, weighed in with her experience. The original posting is archived, but I will quote it in full here because it is so informative:
A previous posting from a colleague in Uganda made passing reference to our project. I would like to take the opportunity to explain and update the list on the work currently underway and the plans for this year.
The Uganda Health Information Network project (UHIN), which currently does use the WideRay ‘jack’ to create a store and forward network, is now entering its third year. The network consists of a handheld computer at each participating health center, an access point located at several sites within each participating district, a centrally located router and desktop computer at the District Health Office. Users enter data onto their handhelds, travel to an access point and upload their data while downloading updates, news and continuing medical education material. Overnight the access point (which has a Linux computer onboard, as well as a data cache a sim card and a battery) makes a call over the cellular network to the centrally located router to exchange data. Data transmitted from each health center is sent by email attachment to the District office the following morning where a conduit automatically moves each file into the appropriate database (disease surveillance, HMIS, etc). Districts then complete the required aggregated reports to the MOH.
A cost benefit study after the first year showed that with only two of the fourteen forms that health centers use to the handheld computer and transmitted over the gsm access points there was a savings of 25% as compared to the paper based HMIS and disease surveillance reporting process. (We have not calculated the cost benefit of being able to provide access to CME through the network.) At this point the UHIN project has been deployed to 160 rural health centers in three districts. The WideRay
‘jack’ is now operating on the gprs network. The monthly cellular cost per health center to transmit routine data AND to receive continuing provider education material, daily Ugandan newspapers and notices from the District Health Directors is approximately $5.35 US – or, stated another way, the per handheld communication cost is $2.45US per month. We expect that a new cost benefit analysis, to be completed this year, will show continued increases in savings. In addition to the reduced costs of using gprs, the training and user support functions to support the network have been absorbed by each district thus reducing overall operating costs. This is possible because the districts have seen real savings by using the network.
But, in response to acquisition cost concerns and a desire to further enhance capability SATELLIFE and our partners in Uganda and South Africa have built a new access point that we expect to start deploying in the next six months. The new ‘Africa Access Point’ will continue to use the gprs/gsm network to transmit data in both directions. It will additionally provide rural health workers with individual email access and will use both infrared and wifi to facilitate exchange with the handhelds that are in use in the three districts. These access points will be about 1/3 the acquisition cost of the WideRay ‘jacks’ currently deployed and
will use all open source software.
The central feature of the store and forward network is that non-urgent information from multiple health centers can be consolidated into a shared access point and that data from each can be consolidated into one phone call /transaction reducing costs and effectively relaying information to and from district health offices to hard to reach (as in a two hour climb on all fours up a mountain!) health centers. We can rely upon existing cellular infrastructure and avoid the costs of building towers, etc. Our goal this year is to expand the number of access points available in the three districts to ensure that these are placed at a reasonably accessible location for health workers. Also, given the current power shortages, we will further expand access to solar chargers for all the equipment.
SATELLIFE and Uganda Chartered HealthNet are working with the Ministry of Health on a plan to expand the network nation-wide in order to support continuing provider development – distance learning for all health workers. We are also about to deploy this kind of network in another country in collaboration with the countryâ€™s Ministry of Health. Finally, UCH will be receiving an award for this project for Public Sector Excellence from WITSA to be presented at the World Congress on IT
meeting in May.
I’ve been in London for the last few days, teaching the advanced track of the RSM workshop. Always fun because of the people I get to meet, but also because of the repeated shocks I get from being in London rather than DC.
For example, the London underground always has amusing adverts. On this trip tax advice compay had several adverts about how somethings ought to be left to the experts. Public speaking, for example, whence a picture of President Bush looking confused with a microphone.
I don’t know why but I was momentarily spooked by the poster. Harmless fun and a joke at the expense of the powerful, but being in the USA I have not seen such images. In London it is a common joke. Not that no Americans make such comments, nor that all Brits believe that Bush is stupid, but a mass market joke depends on the masses believing its assumptions. I guess that such adverts that surprise me are part of the signals that make Americans complain about anti-Americanism.
I also found a charming little book called “Is it Just Me Or I Everything Shit?“. It is full of unnecessary swear words and oh-so-English cynicism – but is so funny! And surprisingly informative too. For example, the entry on Alpha Males (“the Marquis de Sade with a flip chart”) includes this reminder of historical origin:
Dominance hierarchies in the animal kingdom were discovered in the 1920s by Norwegian scientist Thorleif Schjelderup-Ebbe. Studying flocks of hens, he noticed how each member recognised its place above and below its peer; the upper echelons got first dibs at the corn (hence the phrase ‘pecking order’) and peace generally reigned. Clever hens, thought Thorleif Schjeldeup-Ebbe.
Another entry, “Equality of Opportunity”, told me that Michael Young was inventor of the term meritocracy, against which he wrote the satirical book “The Rise of the Meritocracy“. Every now and then I get another glimpse of just how impressive this man must have been, the Open University and the Consumers’ Association being some of his other achievements. And then there is his son, Toby Young, author of one my favourite books, “How to Lose Friends and Alienate People“.
Finally, this morning I read a newspaper article (about the shortage of female “facilities” in the House of Lords) and caught the mention of Thomas Crapper, apparently a Victorian water closet engineer. I know, this is the stuff of primary school playground jokes. But I found very funny after five hours of sleep. Perhaps I’ll pen an apology tomorrow but for now I am unrepentant.
The five papers extracted from my book, “Doctor’s PDA and Smartphone Handbook”, are finally out. I put a copy on my site:
The wonderful Dr Chris Paton did the videos that accompany each chapter of the book (and thus each paper extracted) so we are sharing the credit for each paper.
My wife showed this to me today – searching for “medical facts” on Google brings up a pro-life website. The site seems dedicated to telling women the “medical facts”, no doubt the result of some campaign by Christian bloggers to get to the top of Google’s rankings.
It is interesting to see what searching Google’s country-specific websites brings up:
- Google Canada links to a pro-marijuana legalisation website.
- Google Australia links to weightloss guide.
- Google South Africa links to a quote from Ryan White. I have no idea who this person is, but moving on around the world…
- Google India links to a page about the Munnabhai in all of us. Munnabhai, I am told, is the equivalent of mother’s boy in English.
- I must say that Google Ireland’s top link surprised me the most, a site that tried to discuss the health aspects of wearing the hijab. Apparently a letter to the Independent newspaper claimed that being covered would expose the women to vitamin D deficiency because of the lack of sunlight, but this website makes the counterclaim that the women can reduce their risk of sun cancer. Always fun to see science being used in a discussion that is really about religion.
- Only Google UK links to a non-political website at the top of its ranking, MediChecks.com.