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Dr Applebee is right to be worried about digital promotion of the inverse care law and of unintended consequences, including increased costs (1). Despite continuing concerns over Babylon and GP at Hand, the company have been distributing a leaflet to residential addresses in London with the strap line: “Get well now". Not only implying instant relief of symptoms following a telephone consultation, the flyer also states: "prescriptions delivered to the pharmacy of your choice within an hour". Many doctors would feel that prescribing without seeing and examining a patient is extremely poor medical practice and fraught with risk for both professional and patient. It is also difficult to reconcile with GMC guidance on good practice (2). While this also advises: “check that the care or treatment you provide for each patient is compatible with any other treatments the patient is receiving”, the NHS App designed to be a digital ‘front door’ for all NHS patients is unable to connect with any current providers of online GP consultations (3) suggesting access to medical records is likely to be problematical. A complaint over the leaflet from myself to the Advertising Standards Authority was rejected, the promise with regard to prescribing being justified on the dubious grounds that “both the patient and the consultant GP are aware that a physical examination will not be possible through a virtual appointment such as this”. Fraser and colleagues (4) have highlighted the urgent need for guidelines on robust evaluation of computerised diagnostic decision support directed at patients for safety, efficacy, effectiveness, and cost.
References
1. Iacobucci G. Smartphone GP consultation app cost CCG £150,000 in first two months. BMJ 2018;360:k221
2. https://www.gmc-uk.org/-/media/documents/Prescribing_guidance.pdf_590552...
3. https://www.hsj.co.uk/technology-and-innovation/exclusive-nhs-app-cant-c...
4. Fraser H, Coiera E, Wong D. Safety of patient-facing symptom checkers. https://doi.org/10.1016/S0140-6736(18)32819-8
Re: Digital health: GPs aren’t “Luddites” but want safe, equitable care
Dr Applebee is right to be worried about digital promotion of the inverse care law and of unintended consequences, including increased costs (1). Despite continuing concerns over Babylon and GP at Hand, the company have been distributing a leaflet to residential addresses in London with the strap line: “Get well now". Not only implying instant relief of symptoms following a telephone consultation, the flyer also states: "prescriptions delivered to the pharmacy of your choice within an hour". Many doctors would feel that prescribing without seeing and examining a patient is extremely poor medical practice and fraught with risk for both professional and patient. It is also difficult to reconcile with GMC guidance on good practice (2). While this also advises: “check that the care or treatment you provide for each patient is compatible with any other treatments the patient is receiving”, the NHS App designed to be a digital ‘front door’ for all NHS patients is unable to connect with any current providers of online GP consultations (3) suggesting access to medical records is likely to be problematical. A complaint over the leaflet from myself to the Advertising Standards Authority was rejected, the promise with regard to prescribing being justified on the dubious grounds that “both the patient and the consultant GP are aware that a physical examination will not be possible through a virtual appointment such as this”. Fraser and colleagues (4) have highlighted the urgent need for guidelines on robust evaluation of computerised diagnostic decision support directed at patients for safety, efficacy, effectiveness, and cost.
References
1. Iacobucci G. Smartphone GP consultation app cost CCG £150,000 in first two months. BMJ 2018;360:k221
2. https://www.gmc-uk.org/-/media/documents/Prescribing_guidance.pdf_590552...
3. https://www.hsj.co.uk/technology-and-innovation/exclusive-nhs-app-cant-c...
4. Fraser H, Coiera E, Wong D. Safety of patient-facing symptom checkers. https://doi.org/10.1016/S0140-6736(18)32819-8
Competing interests: No competing interests