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Face to face up to it



If I was to say that, as soon as we are coronavirally able, we should go back to old-stylee F2F consulting, you’d probably speed-dial the mental health crisis team. But that is what I’m saying. Furthermore, I’d respectfully suggest it is you who is batshit bonkers, the victim of an illusion that has mushroomed into delusion.

If you’d just loosen those straps a moment then, OK, I’d admit that remote consulting works for a few things – like Med 3s, some rashes, and admin/chronic disease tasks which barely require consciousness on our part.

But anything else? I’d give a hollow laugh if it didn’t make me sound even madder. Most of us initiated remote consulting overnight when the Covshit hit the fan, because we had to.

And admittedly, it initially seemed fab. Why had we never done this before? I could even consult with my feet on the desk, because a) I felt so relaxed, and b) I literally could consult with my feet on the desk, so long as I turned the webcam off.

But this sudden liberation had nothing to do with a new fabbo-dabbo-techno system. No. It had everything to do with the patients – who, also overnight, had developed an unprecedented resilience and restraint, causing a sudden drop in workload.

Now, that illusion has evaporated as demand has escalated, fuelled by a revitalised sense of entitlement.And I’ve realised that remote consulting makes matters worse.

Patients don’t feel taken seriously unless they’ve had some F2F

After all, 90% of our job is diagnosing normality and reassuring. But these superpowers are undermined by remote working: patients don’t feel taken seriously unless they’ve had some F2F and a ‘thorough examination’ – and, no, a grainy, poorly lit video of an armpit doesn’t count, especially when the armpit’s not even the patient’s, and their presenting complaint is headache.

The result is repeated remote consultations with an increasingly sceptical and disgruntled patient, inevitably culminating in a F2F that could have sorted it in one hit in the first place.

That’s not the only problem. For patients, making and waiting for a remote appointment is so much comfier that it has lowered their threshold for booking one – because they don’t have the significant disincentives of negotiating with a receptionist, dragging their sorry arses to the surgery and enduring the horrors of the waiting room.

This means whimsically arranged appointments, leading to telephone no-shows. And these do not have the tangible buffering benefits of physical DNAs, because we spend the entire 10 minutes dialling, redialling, checking numbers and leaving messages.

It changes doctor behaviour, too. No longer do we accept telephone calls as surgery add-ons. They become phone consultations, eating up appointment availability. This also tempts us to prearrange consultations ourselves. After all, what interaction would you prefer next Monday morning? A chat about a marginally low potassium on that blood test you arranged, or a tirade from some unknown patient bitching about their shit life syndrome?

Just because everyone keeps saying remote is the future doesn’t make it so, and the more they say it in the light of the above, the more deluded it sounds. So maybe you’ve got that syringe the wrong way round.

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

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READERS' COMMENTS [1]

Malcolm Kendrick 6 October, 2020 9:14 am

Amen brother