So I’ve decided to experiment with DailyBooth for a while, and stuck a big picture of myself in the sidebar.

While I get the impression that I’m about ten years too old to join in the DailyBooth phenomenon, I have been thinking for a while that I should stick a picture in the sidebar since I’m trying to make the site seem a bit more ‘personal’, with the handwriting and all… And this way, I get to play with a new website, and don’t have to stare at the same picture of myself for too long.

The implementation is clearly a bit slapdash at the moment (and I know my collar’s wonky in the first picture), but let me know your thoughts – is this a change for the better, or does my face make you want to vomit?

Having a usable computer based internet connection when traveling is great. I am a convert to surfing on the train, and have been for a couple of years now. On top of that, having reasonably priced access to the internet when staying in hotels is always great too.

To this end, I’ve used a number of set-ups over the last few years. Initially, I used bluetooth tethering over 3G with my then everyday Nokia phone. This was great. I didn’t have to carry any extra kit, and I only had to get the laptop out on the train to surf – the mobile never needed to leave my pocket. Great for those moments when you’re absorbed in something and suddenly realise you’re pulling into your station, as there’s little to pack away (as someone who’s very easily distracted, this often happens to me…).

The problem is that this method is slow. And I mean S-L-O-W. At the time I didn’t mind, as I was a virtuous individual who spent most of the time completing BMJ Learning modules on the train. These aren’t exactly data heavy, but even moving from one page to another in those was, well, tiresome with a slow connection.

Contemplating Hagen–Poiseuille’s law (yes, really, I am that dull), I reliased that the Bluetooth ‘pipe’ was the limiting factor to the speed of connection, and started carrying a USB cable. But that was all a bit hassley, getting out the phone, plugging it in, getting it and the computer talking – just hassle, and more often than not I just bluetoothed it.

Over time, my demands became greater. As I said above, I’m easily distracted, and so I started to want multiple tabs open in my browser, just like I do at home. This made my previous system grind to a halt – and as I was paying via my contract phone, I was constantly terrified that I was running up a bill the size of a small nation’s GDP (though, in reality, this never happened). So I went hunting for a new solution.

As a Vodafone fanboy and long-term loyalist, I went for the Vodafone PAYG USB dongle-thingy, That may not be its proper name. The reason I chose it was the fairly fair pricing, in that PAYG credit never expires – unlike all other operators.

But this dongle has its own problems. The biggest problem for me is that it doesn’t (easily) support Linux. When I’m traveling, I’m most often carrying my netbook. This has had a number of Operating Systems installed on it during its lifetime, but has most often run Linux (currently running Moblin, actually). It is possible to jimmy linux into talking to the Vodafone PAYG USB dongle-thingy, but it ain’t straightforward, and it isn’t terribly reliable.

The other problem with this solution is the resilience of the Vodafone PAYG USB dongle-thingy. When on a train – and from the design of this device, this must come as a surprise to Vodafone – there are network blackspots. Tunnels, for example. I can accept losing connection briefly during this spots, I don’t expect mobile networks to defy the laws of physics. But I cannot accept the absolutely ludicrous amount of time it takes the Vodafone PAYG USB dongle-thingy to pick up a new signal and make the connection usable. Particularly when using a jimmied linux connection, it seems to take hours. This isn’t a problem for connecting in hotels, but on trains, it is a nightmare.

Actually, the situation got so bad that when traveling on National Express trains, I started to rely on their Wifi – which anyone who has tried to use it will tell you is a serious test of patience. Oh, and then they made credit expire after 30 days, just like everyone else.

So last week, I decided to try something new, in the form of a 3 Mifi doofer. I didn’t expect much. We’ve all heard horror stories about 3’s coverage, and I’m fairly sure that even they would admit it isn’t the best.

But I have been unexpectedly impressed. The device is simple to operate, even though its five multicoloured flashing lights can be a little befuddling at first. The connection is the fastest mobile broadband connection I’ve experienced, and when a signal is lost, it regains it very quickly and seemlessly.

There’s no hassle factor – switch it on, and my laptop just connects, it being one of my preferred wireless connections, and the device doesn’t even need to leave my bag most of the time. When checking my emails in my hotel last night, I actually forgot I was on a mobile connection. I was watching TV, netbook on lap as usual, MiFi dongle plugging in and charging on the other side of the room. Fantastic!

Initially, I was put off getting a Mifi dongle because of the cost. But actually, the cost is a lot more reasonable than it first appears. For example, when I’m away for the weekend, I’m never really going to want to stream music or watch the iPlayer. I want a decent connection for bits of work and checking my email.

3 gives a 1GB allowance for £10, though admittedly this only lasts for 30 days. But looking at this from a different perspective, this is effectively all-you-can-eat internet for my purposes across a weekend, both at my destination and during my journey. Hotel Wifi would probably give me 24hrs continuous access for that kind of price… Much less convenient, and – for the same level of usage – much more expensive.

So the Mifi dongle is great for me. And for people who want the level of net access on the move that I want, I’d recommend it – so I thought I’d let you know.

There’s a new episode of The Pod Delusion out today – and I feature in it, talking about assessment of junior doctors. It also features Richard Dawkins, which is quite exciting, and lots of other things too. You know you want to listen.

Just a quick note to confirm that I am indeed still alive and well following my overdose… eating a few teaspoons-worth of sugar evidently doesn’t do much harm.

If you enjoyed the video, you’ll probably also like Episode 19 of the Pod Delusion which is out today. It doesn’t feature me this week, which is probably a good thing, and has lots more coverage of 10²³ Check it out!

Also available on Daily Motion
Full details of 10²³ campaign here

Flicking through my Twitter feed this morning, I noticed something about Google prophecying about applications soon been independent on the devices on which they run. I didn’t read any further, but the idea obviously seeded somewhere deep in my cerebrum, as it has been playing on my mind all day.

My initial reaction was “rubbish”. Web based apps are great – I’m a big user of Google Docs – but they’re far from device independent. I can access my Google Docs from anywhere, any computer, and even on my BlackBerry. But I’m not clinically insane, and wouldn’t try and write a dissertation on a BlackBerry. The application might work on one, but that’s not device independence.

But then something occurred to me: Email.

Not so long ago, I used to use Outlook Express to access my email at home. And for a while afterwards, I flirted with various versions of Outlook, Opera, Thunderbird and many others.

In my early years at uni, I had Outlook on my computer and a ZZN email account which would poll the various email servers I used and pull in copies for me to browse on the go when I was away from home.

Later, I had an iPaq – it seems so old worldly now, but it had no wireless or mobile connection. I would only get new email or send emails when it synced with my computer.

For a very long time, my computer was the centre of my email universe. That is no longer true.

Email is one application that is genuinely device independent. My Gmail is pushed to my BlackBerry, but if I’m sat at a computer I’m equally likely to just click onto a browser and access it that way – without a second thought.

I can access it using any computer with equal ease, and with full functionality. Due to their relatively short nature, I’m equally likely to tap out a reply on my BlackBerry as I am to reply via PC.

The idea of waiting, as I did only 5 years ago or so, until I get home to check my email seems hopelessly quaint and antiquated.

Is this level of unity gifted by the nature of email as an application? Or can Google (or anyone else for that matter) replicate it for other functions?

I wouldn’t be so quick to rule it out any more.

The inefficient status quo - surely there's a better way?

There’s been a lot of heat about the NHS National Programme for IT recently, with both Labour and the Conservatives suggesting that it will be, at best, scaled back. Often referred to as “the £12bn NHS Computer”, the idea of having a national IT system for the NHS is often ridiculed as one of Whitehall’s biggest white elephants.

But, contrary to what almost everyone else thinks, I firmly believe that a national NHS computer system is a good idea. I think it has the potential to revolutionise healthcare, and vastly improve the health of the British population in a much more meaningful way than anything else the NHS has ever done.

As a doctor, I’ve worked with a variety of NHS IT systems, some of which are brilliant, and some of which are terrible. On the one hand, I’ve worked with an electronic patient record system in a hospital Trust that is an absolute disaster of a system. It does not fit in to the way anybody works, it is obstructive, and it actually provides less data in a less useful manner than the paper system it replaced. It is terrible, and should never have been introduced. Projects like this give NHS IT a bad name.

On the other hand, I’ve worked with SystmOne in Primary Care, which is a Department of Health endorsed Über success of a computer system. The data is stored in a secure cloud, the program auto-updates, and it is constantly being improved. It’s a massively powerful system. When recent research showed that a high proportion of patients with diabetes and a history of heart attacks would have undiagnosed heart failure, it was the work of moments for a practice near me to generate a list of such patients and invite them for screening. The upshot was that the detection rate for heart failure soared by a factor of ten, and those patients are on the right treatment for their condition.

Without the IT system, this could not have been efficiently acheieved. It would have involved looking through thousands of sets of paper notes, which is just not practically possible. The implications for the availability of this sort of intervention are manifest. And that’s on top of the often sold benefits of all doctors, wherever you go, having access to the same set of complete medical records.

The disease-coding in SystmOne is done in an intelligent and unobtrusive way. If I type someone’s blood pressure in as part of a consultation, this is coded instantly and automatically by the computer, which merely highlights the data to show that it has been entered into an encoded database. Similarly for when I enter a diagnosis – coding is quick, automatic, and accurate. If, for example, I note that someone has diabetes, this is automatically captured and the patient is automatically sent letters for diabetic annual reviews. That is astoundingly clever, and stops individuals falling through nets.

Incidentally, the crap IT system does none of this. It is badly designed by people not familiar with the day-to-day workings of individuals in the hospital, and is actually obstructive when it comes to getting things done.

In most hospitals which remain paper-based, data intelligence just does not exist. The data on millions of pages of paper notes cannot be effectively mined. In order to receive payment for the services an NHS hospital provides, all the paper notes are shipped to a department named ‘coding’, where they are combed through by a team of non-medically trained secretaries, who decide from the often illegible medical notes how many patients with a given condition have been treated, and what interventions have taken place. It is slow, innaccurate, labour intensive, and doesn’t result in a patient identifiable database for mining. It is an extraordinary waste of time and money.

If a system like SystmOne could be extended to cover all NHS care, all over the country, the database it would produce would be immense, and the opportunities for mining of that data would be far more advanced than anything else undertaken by any country on earth. We would know at a glance if an outbreak of a disease was happening in a paticular area of the country. Research could be acted upon in a flash with intelligent, national, targeted screening programmes. And that is just the start.

A well implemented national NHS IT computer system would revolutionise care in the NHS – and frankly, for that, £12bn is an absolute steal.

I’ve recorded a bit on IT in the NHS for this week’s Pod Delusion. Other topics covered include “The Big Freeze”, Google, and ITV’s regions – how can you resist?

I intend to try and remember to add a note here each time I contribute, given that this site was intended to bring all of my writing from all over the internet into one repository – even if that ideal has never really come to fruition.

Plus, I wanted an excuse to use this ‘Diary’ template which hasn’t seen service in some considerable time, but which I think is rather pretty. So there.

Back in September, the Family Planning Association was publicly worrying about the fact we were in a recession. With something rivalling the foresight of Derren Brown, they came to the conclusion that a recession would mean NHS budget cuts, and they were frightened for the future of their service. They thought that a lack of willingness to talk about sexual health issues would lead to their services being the first to be cut. Or, as they more memorably put it, their services will be the first to be cut because

no-one will complain to the local paper about a longer wait to get their genital warts seen to.

Frankly, I don’t think they need to worry so much. Whilst, perversely, sexual health services aren’t sexy, there are much less celebrated parts of the NHS. Like those that deal with children with serious mental health problems.

Back in 2006, I wrote a polemic on here about the underfunding of Child and Adolescent Mental Health Services (CAMHS), and I guess it’s become something of a recurring theme on here. Back in 2006, services were underfunded to such an extent that 25% of the country didn’t have CAMHS crisis teams.  If, like Newt in Hollyoaks, a schizophrenic teenager wants to kill themselves, there was no-one to call to get immediate specialist help. For adults, there are dedicated teams.

We’re now in 2010, at the dawn of a brave new decade, and over the intervening years not much has really changed. Just last year, The Guardian reported how many young people were waiting almost three and a half months for specialist assessment of their mental health problems – with 75% of them having no support whatsoever in the meantime.

Compare that level of service to the sexual health drop-in clinics or the guaranteed two-week cancer wait, and you begin to see the level of neglect of CAMHS in the UK.

Child and adolescent mental health problems are the very definition of unsexy. All of us regularly see tin-rattlers and chuggers asking us to support a whole range of childhood cancer charities, or raising money for hospitals like Great Ormond Street or the soon-to-be-opened Great North Children’s Hospital – All worthy causes in their own right.

But collecting-tins for children with mental health problems are very seldom seen, not because the diseases are less common, but just because of the level of public misunderstanding of the field, and a general perception that mental health problems are unpalatable.

1 in 3 of us will have cancer at some point in our lives. Similarly, 1 in 3 of us will have a mental health problem at some point in our lives. And, thanks to the chronicity of mental health problems, 1 in every 6 people are suffering with a mental health problem right now. And 1 in 10 children have a diagnosed mental health problem.

Which of those statistics have you seen on a TV ad or bus-stop poster recently? I’m guessing only the first.

Thanks to tabloid newspaper obsession and the underactive imaginations of TV and film scriptwriters, popular conception links mental illness and criminality. Criminals and the mentally ill are one and the same to many people. Of course links exist – I’d be a fool to deny that mental health problems are rife in our prisons for example (there’s a post for another day) – but when such vast numbers of people are affected, it is hardly the case than one equals the other.

Problems of perception likely affect CAMHS even more than adult services, as I’m sure many Daily Mail readers fail to believe that mental health problems can affect children: They’re probably seen as a Guardianista cover-up for naughty kids who should be caned rather than mollycoddled. Against that background, I’d wager that many people would rather write to their local newspaper about their genital warts than about their personality disordered child.

Luckily, there are some people out there who care enough to try to change the status quo. There’s a great charity called Young Minds who recently launched a manifesto on child and adolescent mental health issues, in an attempt to influence the political classes in a General Election year with a view to tackling these issues for the long-term. To his credit, Nick Clegg of the Lib Dems seems to be broadly in support of what they’re trying to do.

But the fact remains that CAMHS are chronically underfunded, and definitely underappreciated. As things stand, CAMHS win no political votes, and so when looking for things to cut, they will likely be first in the firing line.

In this context, I hardly think the Family Planning Association needs to worry. As long as preventing teenage pregnancy remains a vote-winner, their services will be well-funded.

Perhaps one day, CAMHS will be able to enjoy that level of confidence and certainty too. For the sake of our children, I hope so.

Recently, I walked through Newcastle and saw a Christmas display that had a degree wit about it – Ann Summers shows its lingerie collection on models wearing antlers with the greeting ‘Have a Horny Christmas’.

Given that it’s Ann Summers, there’s nothing particularly surprising about the message or the sentiment, but it did raise a smile – and a slightly sinking feeling that there’d undoubtedly be complaints about it within days.

The sinking feeling was right – shortly afterwards, the Dean of Newcastle condemned the slogan, saying that it showed a lack of awareness of the spiritual significance of Christmas.

This is surely true of most window displays: ‘Remember how Christmas used to feel’, ‘Christmas wouldn’t be Christmas without M&S’, or ‘Try our Festive After Eight McFlurry’ – none of these has any particular regard for the spirituality of the occasion.

And is it unreasonable to assume that the Very Reverend Chris Dalliston would have been even more offended had the slogan been ‘Have a horny Winterval’? He would probably claim that Ann Summers had forgotten his god at Christmas time.

Christmas in particular brings out the worst in Christians. Many normally tolerant Christians see it as their duty to shout down those who don’t have god at the centre of their seasonal celebration, regardless of whether those people actually believe. Its something that oddly doesn’t happen at Easter – nobody sees Christians lining up to protest about the sale of chocolate eggs which bear little relation to the murderous death and subsequent ghost sitings of their messiah, despite that being the most sacred Christian festival.

And given that Chris Dalliston likely disapproves of most of what Ann Summers sells, he may not be the best person to give them advice on their marketing – though I’m sure they’re pleased that he tried, as it’s no doubt provided a great boost in their publicity.

He claims, of the ‘Horny Christmas’ slogan,

Everyone who can read is being wished this message, which they may not want.

So where is the uprising of the morally bankrupt atheists against the nativity scene down the road in Eldon Sqaure, or the organised disruption of the carol singing in the MetroCentre? I have no particular desire to seek their Christian message, yet it’s foisted upon me. Surely Ariane Shariene and Richard Dawkins should be organising competing choirs singing entirely secular songs and stealing the baby Jesus from the nativity. They are evil secularists, after all.
Yet I doubt that’s going to happen. I actually think you’d struggle to find any rational atheist who was against Christmas in all its forms.

For me, Christmas is primarily about spending time with my family. It is a time for a guaranteed get-together, with nice food, good banter, and presents for one another. So what’s so wrong about that?

My point is this: I don’t actually care what you celebrate at this time of year: Christmas, Winterval, a Festivus for the rest of us, or nothing at all. It’s really none of my business, and it’s each to their own.

But whatever you’re doing today and over the next few days, I give you my very best wishes for all the peace, joy, and happiness you could want.

All the best.

This post is based on my contribution to the Pod Delusion Winterval Special – it’s great, so listen to the whole thing at poddelusion.co.uk