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Total triage; totally toxic?

Total triage; totally toxic?

I love it, I hate it. No, I find my emotions don’t go that deep in general practice. I like it, I dislike it. In a world of increasing binaries – Brexit, Covid – I am going straight for the middle ground.

Our total triage has been live for two months and I loved the novelty and the upskilling of the early days. Every day was a COBRA Covid briefing followed by the next new IT change. The sense of achievement when you have attached an electronically signed sick note to an AccuRx text message cannot be underestimated. Show me a twisted ankle via video link during the depths of lockdown and the sense of gratitude between patient and doctor was palpable. The responsiveness and convenience increased satisfaction and wellbeing for all of us.

Then came the second phase, which was beset by IT outages at exactly the time that demand was increasing as fears eased and people were still stuck at home dwelling on every ache and pain. The depths of frustration and stress engendered by problems that are entirely technical, surpass any heavy duty day pre-corona.  

We are now hard on the third phase, which seems to be entirely normal demand with no secondary care outlet. Add to that staggering number of administrative tasks being heaped upon us by hospitals and we seem to be right back at breaking point.

I still like it for the control over my list. The lack of a full waiting room decreases stress. I bring down as many patients as I think is necessary and I have space to do that. Some doctors who work more days are doing regular home working, there is flexibility for mothers and fathers who do need to do drop offs and pick-ups. I still think it is more responsive and leads to quicker, more appropriate consultations leading to better patient satisfaction overall. We are all better at managing the IT knowing how to avoid the duplication of the early days.

On the other hand, it is a long day staring at a screen. It is bad for the back and bad for our sense of humanity. We cannot dismiss the idea of the therapeutic consultation and the notion of healing which has nothing to do with medication or paperwork.

As a colleague said, it can lead to ‘bad medicine’, undoubtedly true; that twisted ankle for example, she got an X-ray. Then of course there are the potentially missed visual cues, the hand on the door comment, you have to very good on the phone to elicit that.

Like it or not, it is here to stay. We will do it better and add more value than any private contractor offering the same service so we just have to get with the programme. So, it is two cheers for footfall.

Dr Charlotte Alexander is a GP in Surrey


Gonter The Allotment 5 November, 2020 9:51 am

Why are patients being abusive to some? What is the experience for the patient in all this?
For the linked in, signed up and savvy there are benefits but what all patients really want, and dare I say need, is a hands on, I can smell you experience. It’s why I went into this vocation without it it’s just another job.

Reply moderated
Charlotte Alexander 5 November, 2020 1:50 pm

I should add that this was written in September!

Reply moderated
Simon Gilbert 5 November, 2020 2:09 pm

I would suggest calling it ‘total telephone consulting’ not ‘total triage’.

Charlotte Alexander 5 November, 2020 2:32 pm

yes you are right. I am increasingly finding there is an art to it too. The tone of this piece is not really appropriate any more, it was written in early September and a lot has happened since.

Patrufini Duffy 5 November, 2020 2:35 pm

I’d call it “subtotal astute exhausting risky NHS-saving highly-accessible unappreciated slagged off minefield expert professional consulting”. GPs have been doing this for over 30 years. And will continue for another 30 years, when Alexa will have undergone metamorphosis.

Reply moderated
Simon Gilbert 5 November, 2020 3:01 pm

Actually I retract my statement and agree with Dr Duffy’s suggestion above.
We did this for a few years about 5 years ago and gave it up. It’s exhausting having to do it again now.

Dave Haddock 5 November, 2020 7:07 pm

There is a growing market for private practice, with patients reporting they are fed up with being remotely fobbed-off, and wanting to see a doctor.

David Mummery 5 November, 2020 10:33 pm

Thanks Charlotte – I agree with your thoughts. I think F2F has to remain a core element of GP and is actually more efficient, safer and quicker but of course remote has a place : ratio in the end maybe 60:40 F2F:remote? Or maybe 50:50?

Reply moderated
A non 11 November, 2020 2:37 pm

A ticking time bomb of missed diagnosis and accusations of medical negligence for almost every NHS GP ‘processing’ any appreciable volume of ‘remote’ patient encounters. There ate lawyers out there currently limbering up to become specialists in remote medicine screw ups. Are you ready? It was a risky job already.. if we aren’t actually seeing hardly anyone who can honestly claim it hasn’t become a whole load more so?