The NHS has been in the news a lot recently. Big changes are afoot, and about time too. While I am very aware that it is blasphemy to say so, the NHS no longer works well in many areas, and needs to change. It's a constantly evolving being and the way it is managed needs to evolve along with it. Unfortunately this hasn't happened.
I think some of the new proposals are very sensible. Surely if anyone is going to know where money is most needed and best spent it is the GPs on the front line? I hope this plan works and I welcome it.
There is another idea being touted, however, that I don't think is sensible. In fact, it makes me very concerned indeed. The Government is planning to offer patients email consultations with GPs. People will be able to directly email their GP through a new Communicator tool, part of the secure personal health organiser website originally set up to allow patients to view their records online. Remember what a disaster the NHS IT system was to set up? Doesn't bode well, does it?
It's a move the Government claims will improve access to primary care. The word to pick up on is "access". It may well be improving access but it is certainly not improving care. It may possibly work for issuing repeat prescriptions to those with chronic but well managed conditions, or getting results from home test kits such as blood sugar or BP, to update records, but beyond this? No chance.
There is a very good reason why tradition has dictated that doctors bother to see their patients in person, to talk to them, ask them salient questions and maybe even lay on a hand. It's because patients are not generally very good at telling you what is wrong with them. They need help, and it is not always what they say that gives you the answer. Being able to see them, to read their body language and hear the tone of their voice are vital parts in diagnosis. I'll give you an example: chest pain. "Dear doc, I have pain in my chest, comes and goes, maybe a bit goes to my left arm as well. Should I be worried?"
Chest pain can have many causes, heart attack being one, acid reflux another, but it could also be a simple chest infection or even depression manifesting as a pain. Never could this be worked out from an email without either much back-and-forth correspondence (taking up at least as much time as a face-to- face consultation) or a very informed, educated and impartial patient relating the exact relevant symptoms correctly. It won't happen.
I have had good personal experience of this long before any pilot schemes were tried out. Since my TV shows have aired I have been inundated on a regular basis with emails from people all over the world wanting help, advice and diagnoses. I can confidently say that few are easily or quickly answerable, and few give enough information for any sort of useful reply to be given other than "Better go and see your doctor".
Given that the public is spending £2 billion a week on the health service I think it a very sad state of affairs for medicine if a face-to-face appointment with a GP becomes not a right but a luxury.
I was an officer in the U.S. Air Force for 7 years. During that time we went from a yearly "physician's health assessment" that was done in-person in a clinic, to an online assessment which required no face-to-face with anyone. This assessment had questions with indicators that would flag the reviewing doctor of a condition that might need them to see you in person. We always had the option of making an appointment if we were ill or concerned about something, but where the former in-person yearly visit forced people to go in to be checked out, the online assessment did not give doctors an eyes-on review of people.
ReplyDeleteThere are those out there who refuse to see doctors until they are on their deathbeds. There are others who have a symptom they might not realize as serious and don't think to go in for it. And, as for me, I might know something is wrong and INTEND to go in to see a doctor but never find the time to do it if I am not forced.
Overall, while online consultations might provide cheaper, "easier", and quicker access and service, I think it is a really bad change. I separated from the Air Force 6 months ago, and at that time public opinion seemed to be that these online assessments were an indication of decline of care because of budget problems, rather than improvement of care. I don't have any studies/polls to confirm this, but I heard a lot of gripes about it.
So if the NHS is moving in this direction...I don't think they should...
I feel that instead of "going in a new direction", what they should be focussing on is training the triaging nurse and the admitting clinicians in hospitals.
ReplyDeleteThe public will always come for minor insignificant ailments. It takes clinical experience to put a stop to unnecesary escalations 1.e.
Let's do a d-dimer for all chest pain with a normal x ray, including the 15 year 0ld kid with a sats of 97%.......
Which unfortunately translates to wastage and increase in patient treatment time.
Unfortunately, medical training has been deteriorating in recent years and the postmedical education boards are rarely run by people who are medically educated.
You would have noted that "compulsory teaching"for house officers include essentially useless subjects like handwashing, and patient's cultural expectation, manual handling etc. because the education secretaries do not know what happens on the ward and what a house officer should know.
This is a horrible shame because even in some asian countries like SIngapore and Japan, and many of our European neighbours, bedside teaching remains a regular sacrosanct way of eduction. Of course, now consultants have tonnes of paperwork to fill.
Be forewarned that one day when your pecs turn to moobs and you are on a sickbed, the house officer will do hundred of useless blood tests and painful ABGs and every kind of scans under the sun to save himself not you.