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GPs go forth

The human connection

Dr Shaba Nabi

The profession’s general fury with our tech-obsessed health secretary means I sometimes need to remind myself of the improvements technology has brought to our practice.

And it is the most basic one that gives me joy. The ability to text patients has been simply life changing for me. I can use it to convey test results, invite people in for review, send patient leaflets and also prepare the ground for a shared decision-making dialogue.

And texting has a valuable USP: patients can’t answer back. That’s why this timesaving invention is right up there with label printers and self-populating referral forms. When I text patients, they can’t hoodwink me into a buy-one-get-one-free consultation, when you hope to squeeze in a one-minute call to explain a test result, but 10 minutes later you’re still hearing about piles, migraines and indigestion. The cardy-wearers may want a 15-minute chat about lifestyle choices, but back on earth we are firefighting so a quick text will do just fine, thanks.

But on the whole, the march to tech for tech’s sake is having a detrimental effect, and perhaps the worst aspect is a potential increase in health inequalities. Within a deprived area where many patients can’t read English, my workload is actually increasing as I help patients to navigate an increasingly complex system. I fear that as more and more healthcare is delivered via apps, the vulnerable will fall between the cracks.

As more healthcare is delivered via apps, I fear the vulnerable will fall between the cracks

For us GPs, the more remote our consultations – coupled with the increased volume of patient contacts – the more chance we have of burning out. It is no surprise that I feel more fulfilled after a Saturday morning clinic with 15-minute appointments, no phonecalls and no urgent care.

But the truly ugly side of technology is the assumption that artificial intelligence can swallow a complex mix of physical and psychological symptoms and regurgitate a diagnosis. Twitter’s celebrated @DrMurphy11 has shone a light on health algorithms misdiagnosing paronychia as groin strain, and a breast lump as bronchitis. At the other extreme is the potential to turn every chest pain into a heart attack, and every functional symptom into a stroke.

Like most animals, humans require connection. Not with wifi or robots, but with each other. And that’s not limited to patients. As doctors, we also need the non-verbal cues of a withdrawn posture or a baby’s smile, not just for diagnostic purposes, but also to nourish us. A day staring at a screen responding to patient emails and calls may seem more efficient, but is it sustainable?

A trainee once shared a story of a visit to a terminal patient, who was coded as being unable to read and write. As she could not rely on written material, she spent time explaining the condition, prognosis and advance care planning. Towards the end of the visit, when she asked about the patient’s literacy level, he replied that he was perfectly capable of reading, but found he got more time and care from doctors if he stated otherwise.

I sense there is a lesson there for us all.

Dr Shaba Nabi is a GP trainer in Bristol. Read more of Dr Nabi’s blogs online at pulsetoday.co.uk/nabi

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Readers' comments (3)

  • Where's Optimus?

    The assumption that a text has been seen
    could place you into medico-legal tricky grounds..
    See recent case e-script not received by patient
    texts should only be in relation to none urgent logistics like .. make appt etc

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  • "...but also to nourish us"
    Thank you

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  • So very true- consultations are becoming more remote and number of patient contacts is rising. Intensity of work is increasing, in large part due to developments in technology, and so is our risk of overload and burnout. Those in favour of increasing "efficiency" will sooner or later learn that humans have limits and algorithms can only help with basics. To think of it....we are all doomed

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