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Attached student, detached GP


fruit and veg prescription


Call it youthful naivety on her part. Or ‘forgetting to explain the new world of general practice’ on mine. Whatever. When the new medical student on attachment asked: ‘But where are all the patients?’ as she kicked aside the tumbleweed in our waiting room, it stopped me in my tracks.

‘Oh, sorry,’ I said, in the rueful, embarrassed tone of someone trying to explain to a toddler why their Christmas stocking is empty. ‘We don’t do patients anymore.’

Because we don’t, do we? Not physically, not as the default option. We keep them at arm’s length with phone, video or app. It’s not our fault, it’s that pesky new virus they have these days. All of which I gently explained to our dismayed student, though that didn’t stop her throwing herself to the floor in a ‘How am I meant to learn my clinical skills?’ tantrum.

We’re now nearly a year into the remote revolution. Half of us seem to prefer it this way and half of us don’t, but just get on with it. It’s not like there’s going to be a mass exodus of the disaffected, not when we’ve invested years in the job and there are bills still to pay. But what about those new recruits?

In a few years’ time, that ball of fury kicking and screaming on my waiting room floor could have been a fresh-faced GP. After all, there were those fantastic USPs we always trotted out: knowing patients from cradle to grave; being the family doctor; promoting continuity of care; being experts in communication; being trusted by our patients and, most of all, possessing those medical superpowers that went way beyond the FP10 and relied on the good old doctor-patient relationship, in turn dependent on a physical presence.

In roughly the time it takes to say, ‘coronavirus’, that all disappeared. I feel I don’t know who most of my patients are any more. I struggle to picture them, they’re just names on a list or voices on a line. And losing those visual cues undermines much of what was special about general practice. Not just the obvious non-verbals. It’s also the moments of recognition: ah yes, I remember him; of course, it’s them; oh God, not her, etc. Those past interactions are loaded with significance but that legacy is largely lost without the visual cue.

So welcome to call-centre medicine. It’s what the day job has become – but is that a job anyone will be attracted to in future?  It’s not just students who might be put off. Current trainees could be considering a swerve, too – or, at least, a veer towards a portfolio career less elbow-numbing.

With luck, post pandemic, we’ll refocus. The consultation mode pendulum could swing away from default remote towards default f2f and end up somewhere between the two. Not least because the latest GMC guidance warns of the high standard expected from remote prescribing, which I guess signals the end for our dial-a-moxicillin service.

Who knows what lies ahead? But in the meantime, I have a fraught and tear-stained student whom I need to sit down and have a heart-to-heart with. At least there are plenty of free chairs.

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at http://www.pulsetoday.co.uk/views/copperfield

READERS' COMMENTS [4]

Gerard Roberts 24 March, 2021 11:44 am

Expectation shift.
Most patients did recognise that 70 or 80 F2F appointments a day actually took up time, and were perhaps more inclined to wait.
Phone consults however take place in the virtual world, and an infinite amount can therefore fit onto the head of a pin. Hence contacts going up and up.
Thank God I’m retiring.

David Mummery 27 March, 2021 10:17 am

Yes, ‘call centre medicine’ is a bit sh*t…

Peter McEvedy 27 March, 2021 11:04 am

Have gone back to face to face – I hate telephone triage which is also inefficient if you then bring the patient down. We run an on the day emergency clinic which relies on telephone triage and plenty of the other doctors like telephone consults. The only problem are the lists which have been compiled in the last year – but happy to oblige!

John Graham Munro 27 March, 2021 11:10 am

WAS SEEN COMING DECADES AGO—-WHAT DID THE GPs DO?—-NOTHING