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Letter: This digital transformation isn’t real general practice

Letter: This digital transformation isn’t real general practice

One Pulse reader responds to Dr Murray Ellender’s interview about ‘digital transformation, in which he argues that GPs are doing too many face-to-face appointments

Dear Pulse,

I read with interest a recent viewpoint about the ongoing ‘digital transformation’ in primary care.

As GPs, we are currently being inundated by missives from NHS England and digital healthcare companies letting us know that we are undergoing these ‘essential’ changes in primary care, and that they will transform patient care and our role as GPs – whether we like it or not.

The role of artificial intelligence (AI) also seems to be growing, and the feeling is that NHS England would prefer call centres staffed by AI chatbots rather than a fully functioning humanoid GP workforce.

I attended an online webinar about this yesterday, but the system crashed halfway through, and no one could hear what the contributors were saying. Then, yesterday evening, I received an email apologising about the webinar’s ‘technical difficulties’. By this morning, I had received yet another email invite about the AI transformation of general practice, which made me laugh out loud.

Why? Well, it takes me on average 25 minutes to actually log on to the computer system at the practice, then another 15 minutes to load the updates. The electronic record regularly crashes, and I spend an inordinate amount of time watching the wheel spinning around in the centre of my screen.

I have not even tried to do a video consultation recently as it’s so much hassle. Besides, the last thing I want to do is talk to a patient while they’re wandering around their garden putting out the washing, so that I occasionally catch a glimpse of their nose or ear as they hang up their socks.

I cannot examine a patient digitally. Call me old fashioned, but if someone is ill, they usually need an examination (or were several years learning about this at medical school superfluous?). If someone has abdominal pain, they need their abdomen examined; if they have ear pain, they need their ears examined; if they have feet pain, they need their feet examined. You cannot do this without being in the same room as them.

The digital pioneers have totally underestimated the power of a doctor’s unconscious observation while being in a patient’s physical presence. If I call a child in from the waiting room and they run into the consultation room and start smashing up the scales, my unconscious has decided within seconds that it is 99% likely this child will not need to go to hospital.

Others who prefer the ‘digital’ or ‘remote’ method of consulting are welcome to telephone triage or digitally triage the hell out of things over 20 minutes, without getting to any sort of conclusive answer.

But not for me, thanks. I prefer observing, talking to, joking with, seeing visually and, if necessary, examining my patients. I also like smiling, saying goodbye, and opening the door for them. Like I said, call me old fashioned.

Now, in my locum work, I spend at least half the time discussing the mode of consultation and then being a receptionist and trying to fit the patient in at a time that suits them to come in. Patients are confused about what they need to attend in person for, and I regularly have to explain to them, ‘No, I’m sorry, I can’t assess abdominal pain over the phone or computer, and yes you will have to come in and even possibly leave your Zoom work meeting early for the GP appointment.’

I would encourage colleagues to read up on Professor Albert Mehrabian’s 7-38-55 communication model, as it is quite eye-opening about how human beings actually communicate. It states that 7% of meaning is communicated through spoken word, 38% through tone of voice, and 55% through body language. This means we could be missing a lot when consulting patients digitally and remotely.

The viewpoint that got me thinking about this mentioned that ‘GPs are doing too many face-to-face consultations’. If you go into most GP surgeries during the day, the waiting rooms are almost empty, apart from possibly a teenager staring at their phone who has mistaken a telephone appointment for a face-to-face one, and some elderly person being turned away from the desk who has also become confused about the mode of consultation. No wonder the public think that GPs are not doing anything.

It’s a good job I’ve recently retired, and sorry if I sound rather grumpy, but I feel sorry for the younger GPs who think that this ‘digital transformation’ is real general practice. It isn’t, and it never will be.

Digital Transformation? No, thanks. Or, as my GP grandfather used to say, ‘You’re having a laugh mate!’

Yours faithfully,

Dr Burnt Out

(Recently retired, but now a locum GP)



Please note, only GPs are permitted to add comments to articles

Not on your Nelly 30 August, 2023 6:22 pm

Says it all. Thank you. Not soon to retire GP who wants to do a proper job. Not a half job for others to pick up pieces.

Keith M Laycock 30 August, 2023 8:11 pm

Complete agreement – Also retired, after 48 yrs on the job – How anyone in their right minds can endorse an era of ‘digital transformation’ is beyond reason and common-sense – regrettably, sense is not common.

R B 31 August, 2023 11:41 am

Whilst it is true to say that many problems require face to face consultation and examination, many can be effectively managed remotely, either in their entirety or initially with appropriate follow up. Many but not all patients prefer this.
What is more depressing is to constantly hear the old guard lamenting evolution of the model, and harking back to an imagined golden era of traditional general practice. Unfortunately the profession has remained wedded to a model of primary care rooted in nostalgia, folklore and sentimentality. We have driven a level of expectation and dependency that is both unrealistic and totally unsustainable. It has medicalised social problems and arguably caused not insignificant harm in hoodwinking people that we can solve all their problems. What is unarguable is that most doctors cannot sustain more than 2-3 days a week of open ended face to face consultations in their traditional form. This is in no one’s interests and has contributed to the position we find ourselves in.
Whether we like it it or not we have to embrace an age of doctor shortage. Digital technologies are certainly not a panacea and risk driving up demand even further, but what is certain is that what we have done in the past is no longer realistic and never again will be. We therefore have to prepared to adapt, retain the important aspects but understand the need to change. Who is to say what is ‘real’ general practice anyway?

Dr No 31 August, 2023 6:19 pm

Dr Burnt Out is exactly right. Non traditional consults exist either for the convenience of the patient or as a result of the lack of F2F appointments. Both are false. There is nothing about remote consulting that is more efficient for the doctor (the opposite is true) or safer for the patient (ditto). And convenience has disadvantages; the consult is valued less, is more likely to be DNA’D or patient unavailable, and a lower access threshold has been shown conclusively (kings fund) to drive up demand. Also having to set aside time to deal with “digital” crap further takes away time to offer real appointments. The patients supposedly want F2F. They are not crying out for videoconsults or email access/whatever. My patients tell me they see this for what it is, which is a diversion away from being properly assessed/managed and I totally agree. It’s one of the things pushing me out of this professsion.