In conversation with… Dr Paul Tanto, an Emergency Medicine Doctor at Northwick Park Hospital
In this interview we speak to Dr Paul Tanto, an Emergency Medicine Doctor at Northwick Park Hospital.
Paul speaks to us about his unique journey into medicine and his frustrations around the NHS's digital strategy. Prior to becoming a doctor, Paul spent over a decade working in corporate IT.
Paul was interviewed in October 2021 - this piece was originally published as subscriber-exclusive content.
Tell us a bit about yourself and why you chose to specialise in emergency medicine?
“I ended up doing biochemistry the first time I went to university, and then went on to do lab-science-y type stuff afterward. I began to realise that people were being left behind by technology. This initiated my interest in computing, so I went back to do my postgraduate in information technology.
“I didn’t think I had what was needed to become a doctor, but it kept coming back to me and then I thought: “Yeah, fine”.”
“After that, one of my lab jobs saw me co-working in a company as IT Manager. And it was kind of serendipity for me – the science part of the job was being off-shored. That was in the build up to the year 2000 “Millennium Bug” which actually seems such a long time ago now. One day I was sitting at my office window and had an epiphany that this wasn’t what I wanted to do anymore. There wasn’t anything fundamentally wrong with the job, but I had just reached the end of my interest threshold and thought it was time to seek new alternatives.
”I didn’t think I had what was needed to become a doctor, but it kept coming back to me and then I thought: “Yeah, fine”. With emergency medicine, I quite enjoy the challenge of not knowing what's wrong, and then unpicking it and going from there. I know that for some people that's a living hell, but I think the challenge is quite exciting. We also get to make the biggest difference in the quickest time for our patients. And that's really quite a privileged position to be in.”
You’ve previously worked as an IT manager. Since you trained as a doctor how has digital healthcare progressed?
“How can I answer this question truthfully yet positively? They're not the same answer. I think progress within the NHS has been fitful. Don’t get me wrong, there have been some dramatic changes that have been spectacular. But I think there have absolutely been some factors that have held back the process. I think the NHS digital strategy itself is excellent, but the NHS’s digital tactics need a little bit of improvement. For example, I don’t think the piecemeal approach is the correct one.
”But let’s look at a good point - like how quick and how effective the move to using MS Teams was, I think that has been a significant improvement to collaborative, communicative working.
“I think the last time we had a big strategy for IT in the NHS was around the time of 2005-06, and it was a centralisation project. Nothing major has come since.”
”But on the other hand, I don't see an architectural strategy - and I'm pretty IT savvy, and I don't see any evidence of it. I think the last time we had a big strategy for IT in the NHS was around the time of 2005-06, and it was a centralisation project. Nothing major has come since.
”I think another problem that existed when I started working in the NHS - and still does - is printing. Why is printing so problematic? I see no reason for colour printers in A&E. I do, however, see a point for robust high-volume double-sided, full-duplex printers that are Wi-Fi enabled.”
What is the most frustrating thing for you and your patients that could be resolved using digital tools?
“I’d say the number one thing that really frustrates patients and doctors alike is the fact that there’s no centralised database with drug history. Most of our patients are older, and about 10 years ago most of them have about three to five concurrent health conditions. Let’s say, for example, that the patient has high blood pressure, type two diabetes, angina, and COPD. Beyond aspirin, they’ll be on maybe a couple of additional medications. Nowadays, older adults tend to have eight to nine concurrent health issues. And there'll be ischemic heart disease, type two diabetes, high blood pressure, probably glaucoma, possibly COPD, possibly asthma, possibly some autoimmune conditions. So what was previously five or six medicines is now 15. Yes, there is Summary Care Record but you need a smart card, a smart card reader, have been enrolled and given access…Why not a simpler way of synchronising drug and allergy histories across the service?
”If you're having cancer treatment at hospital A, and then hospital B wants to find out what medicine you’re on or how long will your chemotherapy was, it's usually a phone call. But I promise you that the X, Y and Z consultant does not operate at two o'clock in the morning on a weekend, so you’ll be speaking to someone much less familiar with the treatments. A centralised place to access this crucial patient information would make a big difference.”
What do you think is the biggest barrier to implementing new technology in the NHS?
“I think biggest issue is the institutional memory of failed projects. For example, you put in a new patient management system in your laboratory, and it crashes the very next day. Okay, these things happen… but I think what happens then is people can become a little bit of resistant to doing new things just in case it goes wrong.
“Communicating this with users would mean that we end up with better software, better processes, better systems, better end results.”
“Nobody talks about successful implementations, only ever about failed implementations that haven’t quite gone according to plan. That probably came about because we didn't communicate with our users that there are going to be teething errors. Communicating this with users would mean that we end up with better software, better processes, better systems, better end results.”
If the NHS could do one thing tomorrow to make digital a reality, what do you think it should be?
“We need realistic, interoperable software and hardware. I know when a hospital I worked in changed IT systems, it didn't upgrade the legacy system, so somebody had to be hired to transfer data from one system to the other. Three years later, that individual’s salary cost more than the cost of the upgrade would have in the first place. All of that type stuff just has to stop. There has to be demonstrable interoperability.”
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