I was shopping today, browsing through the newspapers when I saw a headline on the front page of the daily express claiming that face to face appointments with GPs are to be abolished, obviously not entirely, but at least vastly reduced. I don't know how much truth there is in this claim, but it did made me think about what the implications would be for the future of primary care physicians in the UK if this was to go ahead. It was implied that they were planning on using skype and other online applications in order to converse with their patients. I don't buy the daily express, so I had a look online when I came home and the daily mail had also run a similar story, it claims that GPs would be using mobile apps in order to view their patients records. This is supposedly going to save the NHS billions of pounds. But what would this mean for medicine, both for patients and for physicians?
My first thought was to consider how I felt as a patient. I'm quite technologically savvy, I use my smart phone how most people who have them do, I have apps for most things the news, social media, journals etc, but how would I feel if I felt the only option I had was for video calls with my GP? I don't like skype as a general rule, I find it slow, hard to hear and it cuts off at times. I have the maximum broadband connection my service provider offers and I have a large computer screen, I'm young(ish) not hearing or sight impaired and yet I'm still not a fan, so how exactly would someone who struggles with technology cope with this proposed change? When some people go to the dr they struggle to get themselves together until towards the end of the consultation when they finally feel comfortable enough to disclose the full extent of their reason for going there, how are they going to feel when they're sitting on skype talking their doctor, not having the face to face interaction, rushed, unimportant and not valued?
I have used NHS direct in the past and almost everytime I've called I've been sent to the out of hours doctor. I imagine that is because the doctor on the end of the phone doesn't know if I'm articulating my symptoms appropriately and wants to check what is wrong with me for him/herself. What if someone calls their doctor on skype complaining that their child appears to have a headache or fever of some description? A lot of people think that the symptom that they have to look out for particularly in meningitis for example is the rash, but what about all the symptoms that come beforehand that a skype conversation may not uncover, if that was indeed the case then I'd imagine that most would agree in saying that it certainly doesn't sound safe, for patients or physicians. I'd like to think that skype would be used for people to call when they want repeat prescriptions extended etc, but it seems like a lot of money to go into the practice just for that; we already have the GP calling you back system rather than going in for a physical appointment if you so wish so is this really necessary if it is unsafe due to the possibility of certain medical conditions being missed?
If you've read this blog then I'm fairly sure by the title alone it is clear I want to be a doctor. How will this proposed change affect the way physician's view their role and their own careers? I think it is fair to say that most didn't go into medicine to sit behind a desk staring at a screen all day, they wanted to make a difference to have face to face contact with their patients and give the very best care that they could, is that possible via the virtual world? How would a doctor feel knowing that their patients were not happy with the new system, wouldn't he/she feel devalued by existing as only a face on a computer screen? What about shared decision making, how much of a decision can be shared when the patient isn't in the same room as the GP?
Although I think it is clear that I'm not a fan of the idea as I can only imagine that in order to save the money stated that physical appointment slots would be cut, there might be a place for it within the existing service. There are many people who have to use up an entire GP slot in order to get their repeat prescription refilled for example, a follow up appointment for medications, people going to the GP about a cold/flu, for these cases it might be beneficial to free up valuable GP slots. However what is the difference in reality between skype and a telephone call which already exists?
The NHS is changing, but for me, as both a patient and hopeful medic, this is a step too far.
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