GPs have been Luddites for too long and must embrace new technologyBMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k2206 (Published 22 May 2018) Cite this as: BMJ 2018;361:k2206
I started working in general practice in the pre-computer era, when we used “Lloyd George records.” These small brown envelopes invited one line entries; anything more would rapidly exceed the envelope’s capacity and need elastic bands to link two or more together. We recognised what we then referred to as “heart sink” patients by the size of their record.
My practice, like many others, began to use computers in the early 1990s for a few functions, such as prescribing drugs and holding summary records. For everything else we relied on paper. When our practice manager announced in the mid 1990s that we would be switching to electronic records, the resistance among us GPs was immense.
Pleaded and argued
We were convinced that the move would wreck the doctor-patient relationship. We said it would interfere with the unconscious processes taking place in the consulting room. We pleaded that the margins of paper records allowed us to read and write those hidden messages that allowed much needed continuity of care. We argued that electronic notes would mean we couldn’t possibly tell how complex the patient’s illness was. “You can’t feel the weight of electronic records,” we said.
Fortunately, electronic records were introduced, and they have transformed the quality and safety of what we do. General practice could not have survived without the move from paper to computer records: the increasing complexity of our cases, the rise in polypharmacy, and a growing litigious culture meant that we had to have a safer way to record and access patients’ data.
Twenty years later we are in a similar transformational era, this time moving from face-to-face to remote consultations. Many GPs argue that digital consultations cannot replace face-to-face contact. Of course, they can’t. Electronic records did not replace the need to record consultations. They just made it easier and safer to do so, and the records more accessible. Digital consultations will do the same for the in-surgery consultation.
Digital consultations won’t replace the need for face-to-face interaction. Instead, they will mean that, when face-to-face interaction does happen, it is more informative, more targeted, and of a better quality. We will, at least, know beforehand what the patient wants from it and whether their complaint warrants an appointment at all.
As with the move to computerisation, it is GPs who are reluctant to embrace this technology. On the one hand, we complain that we are too busy to deliver the care we want to give and that our patients need. Yet on the other hand, we are reluctant to allow anyone to encroach on our territory. (Think of the negative attitude many GPs hold to having physician assistants in the consulting room.)
GPs worry that digital consultations will make it impossible to see patients’ hidden problems. How, they argue, can you pick up the subtle signs of a patient’s distress? They worry that digital consultations, as with telephone ones, just increase rather than decrease their workload.
Digital technology is changing every aspect of our lives. From banking and shopping online to Uber and Airbnb, technology has created a new normal. Harnessing technology and digital innovation is critical to the future of the NHS.
Just as the public expects instant access to bank accounts and to be able to conduct social and professional lives in the digital world, so too will people increasingly expect access to digital healthcare advice through artificial intelligence and electronic consulting to become another new normal. In time, electronic consultations will safely guide patients to the best part of the primary care system, whether that is self care, NHS 111, pharmacy, a nurse, a face-to-face GP appointment, the hospital emergency department, or telephone advice.
This is not about opening another lane in an already busy primary care motorway
This is not about opening another lane in an already busy primary care motorway. I believe that, if GPs embrace this innovation, by 2025 digital technology will have removed the need for three quarters of all face-to-face consultations, giving GPs more time with the patients who do need to be seen, a better quality of care for these patients, and more control to GPs over their working week in practice.
Competing interests: I am a former chair of the Royal College of General Practitioners, a partner of the Hurley Group, and shareholder of eConsult.
Provenance and peer review: Commissioned; not externally peer reviewed.