I don’t mean to brag, but if there was a Nobel prize for primary care, I could be a contender. As it goes, there isn’t – so I’ll have to make do with one of those awards with ‘innovation’ in the title that I’m dimly aware of and which I suspect are presented in a desolate hotel somewhere attended by almost nobody. Because I’ve had An Idea. And it’s the result of the coincidence of a number of events, which, I believe, was how penicillin was discovered. Specifically:
1) We’ve just had a new computer system installed. For the first week, it sent us into meltdown, prompting my registrar to say, memorably: ‘The new system’s fine, it’s when you add patients into the mix that it becomes intolerable.’ By the end of week two, we’ve tamed it and are in awe – a system that seemed to do nothing we wanted will now do anything we ask, and probably make coffee.
2) A young female patient paused a consultation mid-discussion of her acne to take a text message. ‘Is Dundee in Scotland?’ she asked, as she scrutinised her iPhone. I replied that it was. She texted her reply, and we continued in the direction of oxytetracycline as though nothing had happened.
3) I had a discussion with a poor, naive pharmacist who couldn’t believe two things. First, that a third of prescriptions we write don’t even make it to the pharmacy. And second, that this is because we GPs sometimes write unnecessary scripts as a way of terminating the consultation.
4) I’m suffering an epidemic of patients presenting with chilling opening statements like ‘I don’t know where to start’ and ‘I really need sorting out’. Inevitably, there comes a point in these interactions where I want to scream: ‘For f***s sake, don’t you realise I’ve only got 10 minutes?’ So I do. This shocks the patient: not the screaming and swearing, which they expect, but the constraint of time.
So, let’s put all this together. My consultations are too long. We need a legitimate way of terminating them. Patients are blissfully ignorant of our time pressures. They are perfectly happy to accept and respond to text messages during the consultation. We have a fabulous new computer system which is capable of anything.
Bleedin’ obvious, isn’t it? As soon as I press, ‘consult’ on my computer, a software clock starts ticking.
And as it reaches 10 minutes, something wonderful happens. No, an ejector seat doesn’t spring into life, the patient doesn’t fall into a pit of vipers, I don’t pull out a Kalashnikov, nor any of the other wacky and hilarious consultation-ending ploys I’ve described in previous columns, wacky and hilarious though they are.
No. What happens is, my computer texts the patient a message. It says: ‘Your 10-minute consultation is over. Now just go.’
It’s genius. And if any naysayer out there says computers can’t send texts, I say, oh yes, my new one can. I think.
Or, if it can’t, find a way. There’s a day out to a desolate hotel in it for you.
Dr Tony Copperfield is a GP in Essex. You can email him at firstname.lastname@example.org