Carl Reynolds: Doctor and geek
This guest post from Carl Reynolds is part of our series of stories from clinicians who have made a difference in digital health.
In 1985 aged 5 I visited an enormous electronics market called Sham Shui Po in Hong Kong with my father and we purchased a 286. Out of the box the computer couldn’t do much. I enjoyed learning my way around the msdos commandline in order to install games like prince of persia, wolfenstein and bubble bubble. Later we got a 486dx and I installed slackware linux and learned to write simple programs in C. Today, I run ubuntu linux and like programming in Python (Python is heavily used in my research study IPFJES).
One of the most satisfying things about programming is how quickly it often is to move from recognizing a bug to making it go away forever; of course it isn’t always as easy as that but it is often enough to be satisfying.
In 2008 I took up my first medical post as a junior doctor in Basildon Hospital. Perhaps I’d been preoccupied with passing exams when I was a medical student, I hadn’t noticed, or imagined that a large part of my job as a junior doctor would be spent manually duplicating patients names, dates of births, hospital numbers, and clinical information over biochemistry, haematology, and radiology request forms I would deliver by hand. But it was. I had a dot matrix printer and a word processor in 1985, I knew how to program, I knew that it wasn’t strictly necessary or desirable for a human to spend time writing each of the patients details several times on several different forms every day.
Naturally it’s frustrating to have to use broken systems. Ditto for broken software. Knowing how technically trivial it would be to fix bugs that are tolerated, to optimise for user needs rather than vendor needs, and the enormous opportunity cost of not doing so is infuriating.
I’ve tried speaking and writing to anyone and everyone that will listen at the places I’ve worked, at hospitals, arms lengths bodies, and the department of health, I’ve written academic papers, I’ve organised communities around making NHS IT less bad, I’ve set up companies to deliver change. I still see patients in clinic and on the wards, I still routinely have to battle with broken poorly designed digital systems no one is allowed to fix, I still manually transcribe from paper to screen, I still manually hunt down and aggregate data from disparate systems, I still do my best to adapt to and cope with horrible user interfaces.
I’ve not given up but I have chosen to focus primarily on becoming more technically skilled myself because I enjoy it, because it’s useful to me, and because I still hope I’ll be able to make less bad NHS IT happen. I still dream of the day we can say we love the computers at work, they’re ours, we report, fix, or change them when we need — they’re too important to leave broken for long because they help us care for our patients.
