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At the heart of general practice since 1960

What was general practice like before tick-box culture took over?

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In my surgery this morning, I experienced a state of bliss that’s nearly disappeared from general practice. EMIS had one enormous brainfart and, as I sit here ‘on call’, our building contains absolutely no patients. 

The telephone team has been batting them away for the first hour of the morning, asking them to call back in an hour, or visit the local walk-in centre. This delightful pause in activity will come to an end shortly of course: the computer spods are onto it. But or an hour this morning, I’ve actually been able to feel quite relaxed.

There’s been an eerie quiet in the surgery. I’ve just had a coffee with my colleague, exchanged some pleasant chit-chat with a receptionist and shared a joke with the pharmacist. I consulted two patients without any computer records, and even switched the monitor off. Just the patient and me, a blank sheet of A4 and a pad of FP10s.

Is this what general practice used to be like? Did my forefathers actually rely on paper notes and colleagues’ handwriting to manage illness? No mouse to click, no rat-a-tat of keyboards, no awkward silence as the printer springs to action?

My last patient, jovial despite a nasty bout of seborrhoeic dermatitis, seemed to enjoy the attention she got, and the calm. The PC sat mute and unloved in the corner whilst we had a good old consultation without it. It felt as if we were in the playground, ignoring the cool kid with the games console while we played a game of chess.

One of the great arguments for technology in practice is the immediacy and availability of information. In three seconds you can whip out a scope result from 2003 or check the trends in a lipid profile over the last decade: useful, I guess.

If this morning has reminded me of one thing, though, it’s the value of the patient-doctor interaction. Eye contact. Body language. Listening. No typing when they’re talking, no side glance at the QOF alerts.

As I handwrote a prescription for a tub of emollient, just as they did in the 1970s, I wondered if we’d all be better off without our computers.  Then I turned to mine, switched on the monitor and started typing my blog.

Tom Gillham is a GP in Hertfordshire and Specialty Doctor in A&E. You can follow him @tjgillham.

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  • You played chess in the playground?

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