Intended for healthcare professionals

Views And Reviews Primary Colour

Helen Salisbury: “Alexa, can you do my job for me?”

BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l4719 (Published 23 July 2019) Cite this as: BMJ 2019;366:l4719
  1. Helen Salisbury, GP
  1. Oxford
  1. helen.salisbury{at}phc.ox.ac.uk
    Follow Helen on Twitter: @HelenRSalisbury

I should perhaps be grateful to Matt Hancock, England’s health secretary, for his attempts—no doubt heartfelt—to reduce the workload of GPs. The latest wheeze is for the NHS website to partner up with Amazon.12 When people have a question about their health they can ask Alexa, the virtual assistant in their voice activated speakers, and the reply will be preferentially sourced from the trusted NHS site.

I’m a fan of the NHS website: it’s accurate, up to date, and phrased simply, although key words don’t always land you where you need to be. It seems sensible that, if people are going to source their medical advice from the internet, they’re directed here first rather than to other less reliable, often fear mongering, sites.

Privacy campaigners have expressed concerns about what personal data may be harvested from the questions asked of Alexa and how Amazon may attempt to monetise this information, although the company has insisted that it’s committed to preserving confidentiality.

Where I take issue with this plan is the suggestion that it will reduce demand for GP appointments. Most of the people likely to use Alexa are perfectly capable of doing an internet search; conversely, most people who don’t use the internet are extremely unlikely to have, or to want, Alexa in their lives.

Whether it’s through voice activated software or an old fashioned keyboard, how likely is technology to reduce demand? If I type “neck lump NHS” into my search engine it takes me straight to a site about thyroid cancer. Whereas I might previously have thought that it was a swollen gland due to my sore throat, now I need an urgent GP appointment to reassure me.

Even sophisticated algorithms, if they lack live clinical input, tend to increase demand rather than reduce it, as we experienced when NHS 111 replaced NHS Direct.3 This is because there’s no nuance or judgment in a decision tree, and the pathway must be safe in all cases. The default option in almost every scenario seems to be: “Seek advice from a qualified medical professional.”

I wonder how clear a picture our health secretary has of what GPs actually do. On a recent day in my surgery I was helping patients with diabetes and high blood pressure that were difficult to control, dementia, renal failure, anxiety, and unexplained fatigue, among many other conditions. I really can’t think of a single patient whose appointment would have been avoided by looking something up or asking Alexa.

Please, Mr Hancock: can you put aside your fantasies of technological fixes and concentrate on realistic solutions to the urgent funding and workforce problems facing our NHS?

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