Doctors Are Skeptical About Video Consultations — Patients Should Be Too
GP at Hand, the London app based GP surgery is rapidly disrupting NHS Primary Care and clinicians are doubtful. Doctors fear the destabilising effects of this immature technology, and the harms it may cause to the very patients it claims to convenience.
It seems absurd; after all, a video consultation is just a more detailed and usable version of a telephone consultation — something most GPs already offer. So why not just embrace it?
As is often the case, the technology itself is inert and harmless, but the way it is used can be quite the opposite.
Consider the process currently involved with going to see an NHS GP. You first discover a symptom that you think might be a problem that needs addressing. Most symptoms start very mildly then go away, but some get worse or linger, so mostly you just keep an eye on it to see what happens next. After a few days maybe, you think “this isn’t right” so you make the decision to book an appointment. You then figure out you need to phone at 8am to get the appointment that day because you discover the service is pretty full. So you run the gauntlet of the engaged phones and the reception team who want to see if you need to see a GP or someone else. Eventually they offer you an appointment. At 2:30pm. Of course you’re at work then, and you really don’t want to upset your boss by asking for more time off — remember you have that weekend in the Cotswolds coming up so you need an early finish next Friday as well. After a bit of thought you realise, actually I really need this appointment because this might be cancer, so it’s worth the time out of work. 3pm rolls around, the GP is late, but she spends a lot of time listening, concludes your problem is something we can easily treat, and you leave a happy man.
It’s fair to say this is not anyone’s idea of good customer service, even if the end result was positive. However, the system’s awkwardness has one huge benefit: Time.
“The art of medicine consists in amusing the patient while nature cures the disease.” — Voltaire
Most symptoms the body produces, it will manage to heal within a few days all by itself. However, those symptoms may also be the start of something serious that won’t get better by itself. Spotting the difference is incredibly difficult. The current NHS primary care model is based around it being a bit of a nuisance to see a clinician, so doctors and nurses, by the time they see you, assume you’ve either given things a bit of time to sort themselves out, or the symptom must be really quite bad.
Video consulting would change all that. Suddenly, you can book an appointment with your smart phone. No need to wake up at the crack of dawn, spend 20 minute on the phone. No need to wait in a smelly A&E waiting room with actual sick people. No need to think about time out of work, just ask the boss to pop out to a quiet room for 5 minutes and chat with the GP on the web.
Everyone is terrified the symptom means cancer. Always. In that world, it’s natural to want professional reassurance that every minor symptom you have is fine. After all, we keep being told, find it early and it’s easier to treat.
The problem is that 99.99% of the time it’s not cancer. So it helps to give your body a few days to heal naturally before asking for advice and investigations. Otherwise we will suddenly find the need to do lots more investigations, and these investigations can be really quite harmful — colonoscopies rarely cause perforated bowels; CT scans expose you to colossal levels of radiation (causing cancers); MRI scans pick up incidental things that would never have caused problems, but now need to be operated on “just in case”.
Doctors know we can’t put the genie back in the bottle. Video conferencing technology is out there and can be immensely useful. All GPs want is a bit of time for the harms to be considered as well as the benefits, so the technology can be used in a way that is disruptive in a positive way; not a way that swamps the service with demand it can’t possibly meet, all the while harming patients and failing to be any more effective at keeping them well.