Recently, four faxes arrived in my office within 24 hours asking for urgent psychiatric community assessments. They all told separate stories of human misery and asked for emergency psychiatric consultations. It was clearly impossible to see all the patients immediately as I was the only senior psychiatrist covering the team. I therefore tried to call the referring doctors in order to prioritise the patients but could locate only one.
A fax is easy to send. Firstly, you dictate a letter (an illegible scrawl will also do). Then, you give it to your secretary. End of story. Or is it?
A fax is equally difficult to receive. It may get lost or submerged by other papers in an in-tray. It may go to the wrong number, with the risk of confidential material going astray (the police headquarters, social services, or estranged husband come to mind). When safely filed away in the notes, the fax will then slowly fade, making it a useless long term record. A posted copy is therefore essential.
Sending a fax is no guarantee that the recipient will act. There is no dialogue or communication. There is no sharing of clinical information. There is no discussion of safety. There is often no mention of how to locate the patient or what to do if they are out (keep ringing up or visiting until the urgency has passed is one tactic to ensure exhaustion). The letter may not mention whether the referral has been discussed with the patient. Worse, there is no agreement over who has clinical responsibility for the patient.
I may be a technological dinosaur, but I have never got into the habit of using the fax to refer patients. I prefer to pick up the telephone instead. I remember the bulk of my clinical teaching at medical school, as a house officer, and as a psychiatric trainee was geared at presenting a patient to a tutor or colleague. This is a high order skill, perfected after years of training, presumably for the purpose of distilling the salient points of history and examination and communicating them to other colleagues. To communicate in emergencies by fax negates all these skills. Perhaps clinical exams should be replaced with essays that are faxed to the examiners after the patient is assessed.
I am seriously considering throwing the fax machine out of the window. No, better still, I will fix it to work for outgoing calls only.