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The new old norm



I cured somebody with my hands the other day.

It is a rare thing to do in medicine, and a deeply satisfying blip on the usual radar of self-limiting illness.

I reduced an incarcerated umbilical hernia and the instant relief the patient experienced combined with their subsequent gratitude for what I had done, very little in reality except pop a lump back in, made my day.

I relate this patient interaction partly to highlight the fact that despite the negative press we in general practice are often on the end of, patients do still appreciate us. I also highlight it partly to question how the ‘new normal’ we are all being told we have to adapt to is going to work in the three dimensional world.

A technophobe I may be, but there is no bit of remote technology that can lay hands on a patient yet.

Anxious humans want a real person in front of them telling them all is ok

Covid has certainly proven that a reasonable percentage of our work can be done over the phone, but that still leaves the majority that cannot be dealt with remotely.

Lumps, bumps, and even (ironically) skin rashes mostly need a three dimensional assessment.

There is only so much reassurance about abdominal pain – ‘probably just IBS’ – you can do before you need to get the patient in and examine them and yes occasionally, you are going to feel that tumour that has been growing during your telephone consultations.

Reassuring the worried well is a huge part of our work, and I was asked recently why this cannot now all be done over the phone and the simple answer is – the phone or video calls are no substitute for face-to-face or, as we are at the moment, mask-to-mask. I have called in patients for face-to-face consultations who I have spent a long time trying to reassure over the phone and the difference the real life interaction makes is stark. Anxious humans want a real live person in front of them telling them all is ok, not a computer screen.

We may be stuck doing mostly phone consultations for a while longer yet, but my bet is, when this is all over the ‘new norm’ for general practice will largely be going back to the old norm.

Dr David Turner is a GP in North West London

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