Putting knowledge on tap

Knowledge will have more impact on health than any drug or technology likely to arrive in the next decade. Map of Medicine is an essential new 'piping' tool that leads from the reservoir of information to put knowledge on tap, a process that will transform healthcare in the 21st Century. By providing a way of writing down 'what' we want, the Map dramatically helps our chances of achieving it.

Sir Muir Gray, NHS National Knowledge Service Director, discusses Map of Medicine's role in the knowledge revolution transforming health care (5:05)

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Transcription

Muir Gray: Our view of the future is that every citizen and every clinician has a right to clean, clear knowledge. In the 19th century Health was transformed by clean, clear water. In the 21st century health will be transformed by clean, clear knowledge. But how do we get the knowledge to people?

Well my job is to gather all the knowledge together like a reservoir, leave it for a while there, because water stays in a reservoir to let the rubbish sink to the foot, filter it to purify it, clarify it and then pipe it.

Now the Map of Medicine is an essential and new piping tool, it leads the water from the reservoir to the place of use. In the past it came quite close, it came to the door of the hospital but now with the mobile Map and with the Map in the patient record it’s like having water knowledge on tap. So my job is to get best current knowledge to citizens and professionals and the Map is going to be centrally important in achieving that.

Interviewer: You’ve got a clinical background; there may be many clinicians who are concerned about NHS IT products and knowledge products that it’s not actually going to help them in their everyday work. What would you say as a clinician about this tool?

Muir Gray: Well we now know that knowledge is the most important thing that we have, knowledge is the enemy of disease. The application of what we know will have a bigger impact on health and disease than any drug or technology likely to be introduced in the next decade. We also know that people are overwhelmed with poor quality knowledge and it’s the knowledge paradox, they can’t find the knowledge they need when they need it.

We are also in a revolutionary state, we are in the middle of the third Healthcare revolution, the first was public health, second high tech medicine but not the three revolutionary forces are knowledge, the internet and patients. Now I say to friends and colleagues who are clinicians this is what’s happening, we know usually professions are 20 years out of step with society. A GP said to me the other day he said ‘My patients aren’t looking at the internet, only 5%.’ I said ‘Where do you practice?’ he said ‘In a middle class area in the Midlands’ I said ‘Listen, only 5% of your patients are telling you they look at the internet.’ You have to recognise the internet changes everything including clinical practice.

Interviewer: Can patients have too much information because we hear a lot about clinicians having patients coming into their clinics with a little bit of information that can be dangerous?

Muir Gray: What we have to see is that knowledge is part of the clinical transaction and about five years ago a lot of clinicians were anxious about us giving information to patients. But let me try and summarise the evidence about patients or citizens, let’s call them citizens.

Firstly some citizens are more intelligent than clinicians, 5% maybe, 10%, I live in Oxford, it feels like 25%. Secondly patients have more time than clinicians. Thirdly many patients have only a single problem to deal with. Fourthly the choice faced by patients is often dreadful but simple, for example if you are making a decision about whether or not to have your gall bladder out you don’t need to understand the molecular biology of bio acids, you need to know what is the probability of benefit, what is the probability of harm and what are the nature of the benefits and harms. So the decision we made about five years ago was to make everything open to clinicians and patients and let them find their own level and for the future I see, and this is a plan, we will send people information before the consultation for them so they will have prep before hand and homework afterwards and I know there will saying, immediately clinicians will think ‘I know a patient who doesn’t want to do that.’ But the evidence we have is that we always underestimate what patients want and how much more they want to be involved.

Interviewer: As a representative of the Department of Health, how is the Map specifically helping you to deliver what you as a Department have promised?

Muir Gray: Well as I say the gap between what we know and what we do yawns like the Grand Canyon. Now knowledge alone does not bridge the Grand Canyon but having a way in which we can write down in a form that people can understand what it is we want dramatically helps us achieve. If for example you ask ‘what does the NHS want for rheumatoid arthritis?’ I cannot show you any document other than the Map of Medicine. We have to write down what we want and then there is half a chance that people will do it.

Interviewer: Sir Muir Gray thank you very much for your time.

Muir Gray: Thank you.