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I hate fax machines. I really, honestly loathe and detest them. They may look innocent enough, squatting there in a corner, occasionally humming to themselves, but I can see through their bland plastic facades to the pulsating malignity beneath. Maybe they aren’t the health service’s single most pressing problem, but they are a symbol of much that is wrong with it.
Certain middle managers will solemnly assure you that faxes are more secure than email. This may be true – but only because, since virtually nowhere except the NHS uses faxes anymore, even if you enter the wrong number your message is unlikely to be delivered anywhere outside the healthcare sector. (Although I gather faxes are still widespread in North Korea, due to that country’s extreme technological and economic isolation. I like to think of Kim Jong Un perusing our misdirected referral letters, doubtless gleaning valuable insights into life under the capitalist oppressors.)
Or your fax might go nowhere at all – unlike with email, you can never tell if it’s sent successfully. If an answer is sent through the same medium, the chances of you ever seeing it are slim. And that’s assuming, of course, that you could persuade the machine to work in the first place.
A transition to email is taking place, but painfully, slowly and erratically. One department I know of prints a defunct email address on its referral forms, apparently to avoid the embarrassment of admitting they haven’t figured out how to use a computer. If, a few weeks after your referral has disappeared into the void you call to enquire after it, they will explain without any perceptible embarrassment that no-one has checked that account for years – and give you the fax number instead.
So why are we stuck with these inconvenient, unreliable dinosaurs? Many of the NHS’s woes are down to resources, but surely maintaining squadrons of increasingly hard-to-source fax machines can’t be cheaper than email? I suspect the key is fear of blame. If you take responsibility for a change in practice, however sensible, then when something goes wrong fingers can be pointed at you. If you stick with familiar usages, however absurd, no-one can accuse you of doing anything worse than your predecessor.
It’s become a cliché that the NHS is one of the last organisations in the developed world to use faxes. Nevertheless, a large number of my non-medic friends – and patients – simply refuse to believe it and assume I must be pulling their leg if I mention wrestling with a malfunctioning fax machine at work. Let’s hope that, for the next generation of doctors, fax machines really will be nothing but a bad joke.
By the Secret Doctor
Read the blog and follow @TheSecretDr on Twitter and on Facebook
I see the email security issue as an example of the perennial need to invent a "bespoke solution" when none is needed. Go to your ubiquitous copy of Outlook. click on File then on options, Trust centre and finally email security. There lies a mechanism present in Outlook for over a decade to encrypt emails so only the correct recipient can read them. The NHS would simply have had to take on the role of public key authority ( a technology available form BT amongst others.) but it could not be agreed so roll on fax machines. how many other hopeless bespoke solutions litter the NHS?
Why faxes? Only one reason I can think of - and only for urgent stuff; Because they don't rely on the person who knows how to get into the email account to actually be available. This is a big issue for urgent sharing of information , especially when temporary staff only are running a service - not so rare! I have never seen a "locum pack" with information on how to access a practice's email account, but anyone can use a fax machine.
So that secondary care can fire and forget their crock of shit demands to their community house officers *cough* I mean GPs.
Sadly emails do not solve this issue either.
The URGENT label sneaks the damn things past our admin supervisors like the HMRC TAX REFUND email I clicked on last week.
Only recently I tried to return an email to the midwives 'URGENT Please prescribe antibiotics for this lady who has a positive MSU. You can find the result on the hospital system.'
After 6 hours no response I called them up...
'I'm sorry but we don't check the emails after midday.'
I cant believe these things havent been stamped out on the basis of (potential or real) confidentiality breach - one incorrect number dialled could see all manner of clinical information delivered to god knows where....
Almost every time I use a fax machine, I think of the confidentiality problems. I don't know who's standing on the other end of the fax machine. I don't know if this number is correct. All that confidentiality training we do, all the posters, all the online modules, all the medicolegal implications, and we're still pumping key patient information through machines into what could be the local accountancy office for all I know.
Re: accessibility. The fact that fax machines can be accessed by anyone IS the problem. All new employees have an email address, and there are many communal email addresses too. There is simply no excuse to use email - the rest of the world (I won't even say the developed world) sends all information by email.
Additionally, most Psych hospitals and trusts use emails solely. The one I used to woek at had computers everywhere and EPR.
Slightly surprised by the comment about psych hospitals and emails: ours certainly doesn't do that. Your best bet is someone's nephew answering the phone who doesn't know how to pronounce the doctors' names, nor can he spell them out from the piece of paper in front of him spelling them out. And nor does it update its records from one year to the next, nor incorporate the "new" information from a GP into said records, which are apparently still kept on paper and transported around the hospital by porter with a lead time of at least three weeks to move the few hundred metres from one side of it to the other (at least according to at least two consultants I spoke to, and where extensive evidence bears this out).