Online access has us dead and buried

As online access turns triage into an unending, oxygen-free ordeal, Copperfield asks whether general practice can claw its way back to the surface

I have to admit I have some sympathy with the GPCE and their alleged mismanagement/miscommunication/mishmash of cock-ups around the contract regulations. Imagine what it must be like working all hours, having electronic messages flying in from all directions and having to diligently digest or divert as appropriate.

But you don’t have to imagine very hard, do you? Because that’s what we’re all doing now, thanks to that online access they have these days. If we had thought that mandated all-hours triage might be the final nail in the coffin, all I can say is that we might have actually underestimated it. As well as sealing the lid, it leaves us six feet under.

What has really struck me after a few triage stints is the hazardous lack of boundaries. Patients can contact us about anything, from anywhere, at any contractual hour, as often as they want, with minimal or incomprehensible information. I have to take quick and perilous decisions. I might as well be working for Medecins Sans Frontieres.

Here are some examples from yesterday. A man who wanted an appointment because he felt, and I quote, ‘ill’. That’s it. Hmmm, quite a wide differential, and one that even the Vague Symptom Pathway might struggle with.

At the opposite end of the spectrum, the son of an elderly man asking for a visit for a ‘number of minor problems’, that number totalling 12, and the message amounting to less an online communication and more a plotless novella.

Then there was the young woman who thought she needed antibiotics for an infection. Where? Two answers: a) In her lungs b) In Istanbul. I suggested she seek medical help locally and, no kidding, she sent a further message three hours later saying that the local help hadn’t been helpful and what should she do now? I dunno, maybe visit the Blue Mosque?

Which nicely illustrates that lack-of-boundaries sensation. But this doesn’t just apply to geography: it affects consultation border-control too. Interactions can go on forever. I’m not triaging, I’m an online ChatDoc.

Hence, Woman With Sore Throat (WWST): ‘I have tonsillitis.’

Me: ‘Try Pharmacy First.’

WWST: ‘I’m not going to the pharmacy, I need antibiotics.’

Me: ‘Pharmacy First can provide antibiotics if they’re needed.’

WWST: ‘Are you sure?’

Me: ‘Yes.’

WWST: ‘I want to see a doctor anyway.’

So she sees me and, no, she didn’t need antibiotics and, yes, she’ll probably call 111 later.

All of which means, paradoxically, that I forgive the GPCE if there is actually anything for which to forgive them. Information overload is difficult to manage. We are where we are, and where we are now is dark, cold, and lacking oxygen. The big question is: can we be exhumed, or will we be left to rot?

Dr Tony Copperfield is a GP in Essex