“Online consultations in general practice: the questions to ask” RCGP Report.

RCGP Online Consultations in General Practice the questions to ask

The Royal College of General Practitioners has been “working with a group of Patients, GPs, health service managers and academics to develop a set of questions that you might want to consider if you are a patient, clinician, practice or commissioner” interested in using these online consulting services.

Download the “Online consultations in general practice: the questions to ask” report (PDF).

mHealth Insight

At times the RCGP seems fixated on efforts to detract from efforts to evolve general practice beyond the office visit only model but I think this is a fascinating document and it will provide a great launchpad for discussions about how services should be designed.

“Online services provide a new way of consulting in general practice. Use of text based or video digital technologies has some advantages over established ways of consulting such as face-to-face meetings or the use of the telephone. It also carries risks.”

While I agree that booking an appointment is an online service it’s disappointing that the paper refers to “consulting with a Doctor” as just an “online service”. Similarly to how Video Consults with Doctors shouldn’t be described as ‘Virtual Consults’, I think there is a distinction that the report would benefit from making clear that becomes particularly obvious when you realise most internet access comes via the mobile phones that most of us carry and never switch off (which makes it unclear when a Patient using a mHealth service or a GP or Nurse who shares their mobile number with a Patient would consider themselves to be online or off-line).

I also find it a bit of dangerous presumption that documented mobile video consults are accepted to be inherently more risky than a conventional face to face meeting in a clinic or a plain old telephone voice call when surely we all know Patients are more honest with their Mobiles than their Doctors, surely we all know there are Patients having consults with overworked GPs that are little more than stranger encounters and the college is aware of the great work being done by RCGP members who are providing online tools to their Patients that are helping them to work at the top of their licence. (Related: “The biggest “disruption” in healthcare is honest, direct, accessible communication” (2012)

“We present some questions that you might want to ask if you are a patient, clinician, practice or commissioner, to help you to get the most out of the potential of these new services. The questions have been developed by a small group of patients, clinicians, health service managers and academics working with the RCGP and are currently being tested more widely, prior to be being published on the RCGP website”

I would’ve loved to have helped contribute to this work as it really does seem to be missing the most valuable potential contributors eg. how could the questions that “Practice Nurses” and “Carers” might want to ask have been overlooked?

I personally think Carers make the strongest solid use case for GPs to start offering mobile video consultation services because these invaluable volunteers deliver some +80% of total healthcare and they are all too often unpaid (and missing out on the opportunity to work/get paid) and medically untrained. In my experience the value of having a Video Consult with a Doctor on your mobile is probably most significant for Carers.

“Questions to ensure that the service is safe: Has the service been inspected by the health regulator, the Care Quality Commission (www.cqc.org.uk) (or its equivalent outside England), and am I satisfied with the report?”

It’s a bit odd that the RCGP has become a big fan of the CQC’s ability to protect the safety of Patinets. Perhaps everyone’s forgotten that the organisation (that gets by on a measly £262Million a year) published a banding system that wrongly labelled 60 GP practices as “potentially putting patients at risk” when they weren’t.

I think it’s important to appreciate that a Doctor video consulting service becomes safe when it’s properly documented for Patients and is provided by registered Doctors. Fail to document or let Patients even access records and we just continue to support the growth of pointless bureaucracy and clipboard-wielding parasites who ultimately take funding that we really need to be allocating to those who are actually providing care.

“Will the online provider have access to my GP records so that they know about my medical history?”

I think this is something that’s rapidly changing. As Patients get access to their records (something that the paper doesn’t refer to) mobile health apps like Apple’s new Health Record service are going to flip this question on it’s head eg. it will soon be more sensible to ask “will the service let me securely share my Healthcare Records with the remote Doctor”.

I think this is very interesting because we know Patients are more honest with their mobiles than their GPs so it’s likely that these Patient accessible records are going to be much more useful for GPs.

“Is it clear whether my personal information is being kept safe and confidential? Will it be shared with other parties (including my registered GP if appropriate) or used for purposes other than the direct provision of care? If the online provider wants to record my consultation, will I be asked for my permission to do so?”

I think these are great questions but they’re not going to be realistically solved by us hoping that Patients will remember to ask it at a time when they are all too often stressed and in urgent search of health advice.

I think the RCGP could have impact if members were to draw up an approved T&Cs and Privacy Policy that their members should work with when advertising their services online. By doing this RCGP members won’t be seen with their mugshots plastered all over the scammy websites that advertise free* or cheap subscription services directly to the public but hide behind protracted T&C’s and Privacy Policies that state they aren’t Healthcare Professionals and are nothing more than “providers of a website” and not responsible for healthcare or advice given while informing the 1% who bother to read the small print that they have (automatically because they visited the website) granted permission for the website owner (or the liquidators when it’s VC debt funding runs out) to share/sell everything with third parties who can use it unaccountably for whatever purposes they want.

“Does the online provider offer services for people who are not able to consult in English?”

It’s interesting to note that this report from the RCGP is only made available in English.

“Questions about how the service is provided: Is a free NHS service being offered or will I have to pay for it? If I have to pay, how much and what payment schemes are available?”

I think this is going to be one of the biggest challenges facing Patients. Already we’ve seen free* video consults with Doctors offered by a range of website owners including some of the biggest corporations in the world and I think this paper could’ve done more to help educate Patients and Carers to this major issue and perhaps even offered suggestions to regulators (like the GMC, advertising standards agency, etc).

It should be made obvious to our Patients that their personal health data is worth more money than a few minutes of a Doctors time and that there are unscrupulous business people who know this and see it as an opportunity to get rich quick. I think it would be very sensible if the RCGP lobbied for legislation to be put in place to force corporations that market “Doctor consults” to not be using that statement as just a marketing headline to masquerade their real business model (which is to profit from the selling on of Patient information that they get from giving away or subsidising Patients so that they have an easy to use inexpensive opportunity to chat with a Doctor).

It’s interesting to note that in countries like the USA you would be sent to jail for involvement in this type of activity (yet it’s still commonplace in the UK).

“How much do I know about the qualifications, background and interests of the doctor who is advising me?”

I think this is an interesting question because it presumes that the best model is the one we have today with office visits where the Patient selects the Doctor. I think it’s becoming increasingly obvious that as we use and share information more productively we should flip this model and have Doctors selecting Patients based on their own particular strengths, personality and experiences.

“Am I able to get a follow up appointment with the same doctor who saw me first time?”

I’m surprised the RCGP isn’t maintaining the line that we have used here at 3GDoctor for the last 10 years that states “the best place to get care is with your Family Doctor”. I don’t think it’s particularly healthy to be encouraging Patients to become dependent on a particular remote Doctor and through the use of modern medical record documentation tools it should be possible for Patients to find continuity with a different remote Doctor or to get follow on support and advice from their Family Doctor.

“Am I confident that I will be able to provide as safe clinical care online as face-to-face? If not, how will the risk be managed?”

I don’t think there will be any Doctors who are going to be able to confidently say they can provide clinical care remotely as safely as they can provide it in an office because there are clearly practical things you can do in an office to ensure the safety of a Patient (obvious things like lock the door and call for assistance) that won’t be possible in a remote setting over a video call, but this should never be a reason to not make it more convenient for Patients to connect with Doctors because the reality is you’re naive if you think alternatives won’t be sought by Patients or that marketeers working for quacks won’t reach these Patients online. In 2018 by making registered Doctors harder to access we’re just making the services of unregulated services more attractive (remember the global sham ‘alternative’ medicine market is already generating sales of $200Billion a year and it’s a lot harder to dispel misinformation than to create it).

“Can I be confident about the identity of the patient I am providing online care for?”

I think we should also provide the capacity for Patients to anonymously obtain the independent impartial advice of a registered Doctor. The BMA offer this to all Doctors in the UK so I wonder why many Doctors don’t think that Patients might also value this same type of anonymity.

We should appreciate that anonymous services can be a great opportunity to start helping Patients who are putting off seeking help because they are too nervous or uncomfortable about a concern to initially share it with their family Doctor.

“Am I confident that the consultation is confidential, for example that no one else is listening in without the patient’s permission?”

I think the much more significant threat comes from the websites offering video consults with Doctors that have business models that are all about selling information and recordings of video consults onto third parties.

“Will there be any changes to my current indemnity costs?”

It absolutely amazes me that Doctors who prescribe medicines to strangers via websites pay the same medical indemnity costs as those who only see registered Patients in their office where they have access to their health record and a familiarity with their family and social background.

With huge year on year increases in costs it’s time more Doctors starting asking their professional medical indemnity provider if they are providing cover for Doctors who are working for these websites with scammy T&Cs and Privacy Policies because if they are you as another member are subsidising their massively increased risk profiles.

“Will I be part of a peer network so that I can seek help or support and avoid any risk of professional isolation?”

A bit of an odd one that as I think the RCGP is incredibly well placed to help with this and is really failing it’s membership on this front eg. wouldn’t it be great if the RCGP offered a community service like Doctors.net.uk for members?

Related Posts:

Can a quick phone call substitute for a doctor visit?

The doctor will see you now: NHS starts outsourcing mobile video consultations

“So, exactly why would one need to video call a doctor vs. just talking to them?”

If Patients see you uncomfortable using a mobile they may doubt how current your medical knowledge is

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E&T: Health apps frequently neglect privacy of users, study finds

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Hilary Lamb at Engineering & Technology reports on a study that has found “Health apps frequently neglect privacy of users”.

mHealth Insights

“A European study has found that half of health apps could be sharing sensitive personal data via insecure connections, and the majority of these apps share health-related data with third-party companies. The study involved a collaboration of researchers from the University of Pireus, Greece, and Rovia I Virgili University, Spain, who are working to develop improved solutions to protect European citizens’ online privacy. The researchers looked at 20 free apps available on Google Play, all of which had been downloaded between 100,000 and 10 million times and had a minimum rating of 3.5/5. They studied how the apps stored and monitored personal data, such as information about past health conditions. Of the apps analysed in the study, 80 per cent shared health-related data to third-party companies, with the other 20 per cent storing data on the users’ phones. This data included text as well as images, such as X-rays”

While I recognise we have a dire situation in which caring Healthcare Professionals are shaking in their shoes for making the decision to share their mobile number with their Patients I find it amazing that people are really surprised by this finding. I wonder how people who think this is the big issue of the day react to discovering that the biggest Cancer Charities in the world are using private investigators to research the families of people who have cancer so that they can then profile them for highly targeted donation strategies based on their personal wealth etc?

The reality is most of these app users will have public Facebook profiles and likes that would probably tell you more about them than you’ll achieve by hacking the citizens mobiles or the websites they’re interacting with. With some resources and considered use of keyword advertising you can probably engage them too (because as we know most Patients are googling their condition/diagnosis).

I also think the research could’ve had a lot more impact had the top line findings included the names of the 20 free apps, the developers and their partners, if there was evidence that they were being recommended by Medics and Patient Associations, how long Patients used these apps for (we know most apps just get downloaded and soon after are deleted), etc.

I can easily point you to 20 free ‘health’ apps on Google Play that fall into their criteria that are just nonsensical and have 3.5* ratings and 100,000 downloads but they’ve got that because they’ve just gaming the app store, making money via scams and users aren’t Patients but are citizens using it for fun/discovery.  Here’s one I found within 5 seconds that meets all the researchers criteria and there are thousands of cookie-cutter similar apps that promise like this one does to give a ‘Doctor Diagnosis’ based on a paint by numbers approach to collecting basic symptoms:

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There is probably also no way that the researchers could identify if these apps weren’t just being used by ‘users’ that weren’t actual people/Patients eg. click farm operations can make lots of money from dumb mobile advertisers if they get the context right (it’s easy to imagine the dumb drug companies and the ‘charities’ they sponsor would be very gullible to spending on these type of ads), etc.

“Only half of these apps shared this data securely, using https connections to manage user login. More than half of the apps transmitted data using URL links: this made the data potentially accessible to anybody who could gain access to those links. 20 per cent of the apps did not refer users to a privacy policy or failed to do so in the language of the app. Some of the health apps required access to camera and microphone, contacts list, external storage, Bluetooth and location, despite their functionality not being dependent on this access”

I think it’s interesting to that only half of the apps shared personal Patient data securely but 80% referred users to a privacy policy. Until the app stores start enforcing standards Privacy Policies are meaningless: no one is reading them and they’re for the most part just providing a smoke cloud of false reassurance for Patients.

I’m a huge fan of Patient Champions and think it would be interesting to see what level of endorsement the apps reviewed by the researchers were getting from Patients (I don’t think that a +3.5 star app store rating is a proxy for this), Medical Professionals and healthcare provider organisations.

Related: NIH funded researchers spend $270 on misleadingly labelled iPhone apps & conclude that apps offered for ‘EDUCATIONAL USE ONLY’ can’t be relied on for ‘PROPER MEDICAL ADVICE’

“According to the study, the majority of the apps did not meet legal requirements or standards intended to protect users from inappropriate data use and disclosure to third parties. “We strongly support the use of mobile health apps, but users must know that apps’ popularity does not ensure privacy and security,” said Professor Agusti Solanas of Rovira I Virgili’s department of computer engineering and mathematics”

I think it’s clear this is like other minimally regulated markets (eg. the $B supplement industry) and I think a better piece of advice would be for Patients to download and use apps that have been recommended to them by their Healthcare Professionals (who have undertaken quality mHealth training from an accredited training body).

“The issue of health data being shared insecurely has been a concern for years. It has been reported that UK doctors frequently use their phones to share personal health data with their colleagues, including sending text and pictures via SMS to request their professional opinion. In 2015, the NHS was forced to remove health apps from its library of accredited apps after they were found to be leaking patients’ medical details online”

Of course Health data shouldn’t be shared insecurely but there are also issues with how health data that is being shared securely is being used and shared that this report doesn’t seem to touch on eg. Patients in the UK’s NHS gave their health data to medics and it was then given free of charge of an advertising company in the USA that we know is making billions in profits from doing things like selling adverts to referral agents that are masquerading as free helplines for addicts etc.

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and this is all before we start thinking what smart connected homes are chattering away about…


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The HomePod smart speaker is differentiated because it’s Apple attempt to sell you a smart speaker


In this excellent review by Om Malik I think it’s abundantly clear that with Apple’s new “HomePod” smart speaker they aren’t trying to compete with Amazon’s Alexa or Google’s Home. They’re trying to delight customers of the high end speaker/audio brands whereas Google and Amazon have products that are being used to try and sell advertising and more goods.

I think there are some good analogies here with Apple’s approach to Healthcare that isn’t focused on reimbursement is different from practically every other major brand. Apple won’t need to compete with the Electronic Record Corporations that sell to governments and insurers nor will it need to overly worry about brands like Google or Amazon (who want to sell your information or sell you on more healthcare services) they’ll just need to communicate why you need to be wary of too-good-to-be-true & free* services and can trust them and the services they provide to you (and those you care for).

The future belongs to those who are doing things today to build a virtuous cycle of Attention and Trust.

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Apple’s Health Records App: A Ripple or a Roar?

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This blog post by Dr Joe Kvedar reflecting on Apple’s Health Record announcement makes for interesting reading (I’m very optimistic about what this means for Patients and Carers).

mHealth Insight

“To quote Yogi Berra, “It’s déjà vu all over again.” Or so it seems. Last week, Apple made a big announcement that headlines and excited many in our industry. They have enlisted two of the largest medical records companies, Epic Systems and Cerner, as well as Athenahealth, and a number of respected healthcare institutions, including Johns Hopkins Medicine, Cedars-Sinai, Penn Medicine and UC San Diego Health. And, according to their press release, they have built their newly updated Health Records app based on FHIR (Fast Healthcare Interoperability Resources), which is the interoperability standard for transferring electronic medical records”

I think it’s natural for those working in the US Healthcare system to think this is all nothing new because they have no real idea what to expect from a giant Mobile company that can afford to be focused on the needs of Patients and Carers (and not on reimbursement).

The Clinical Research industry thought ResearchKit was nothing significant until they saw it set new records eg. for Patient Recruitment (the biggest issue facing the industry eg. most trials in Europe fail to recruit enough Patients).

“This is all good very good news. I might add that Apple has build an undeniable reputation on their ability to create beautifully designed and highly intuitive software and highly integrated hardware. I dare say, no one does it better. But I can’t help but recall similar attempts to create health data repositories for patients on their mobile devices. In 2012, Google shut down Google Health after just three years due to “lack of widespread adoption.” Microsoft HealthVault has also seen its share of challenges since it launched in 2007”

I think a big difference is that none of these organisations have ever had their CEO state clearly that they weren’t going to be prioritising reimbursement. It’s actually all they were about but beyond that these were small scale projects that let Google and Microsoft look innovative while they continued to make billions from business as usual eg. Google continued selling billions of pharma and quack ads, Microsoft continued to sell £multibillion software licenses to Healthcare organisations, etc.

In stark contrast Apple’s senior executives are on record stating that the healthcare market that they seek to transform will dwarf the trillion$ smartphone market that they already dominate.

“Of course, Apple entered the health market in 2014 with its Apple HealthKit which, to date, has not been the game-changer it was originally expected to be. A few weeks after the HealthKit launch, I actually catalogued my wish list for Apple HealthKit, and several themes from that 2014 post are still very relevant”

To say HealthKit isn’t a game changer is classic Amara’s law (eg. We tend to overestimate the effect of a technology in the short run and underestimate the effect in the long run).

100 Million Patients and Carers have a native healthcare service on their mobiles (devices that they trust, carry and keep switched on 24×7 and look at 200+ times per day) and Apple is already getting to decide which brands win or lose in the global medical device market.

“While I applaud Apple and their partners for this latest attempt to put personal health data into the hands of consumers, we should keep a few important caveats in mind. Why haven’t these tech giants — and others — been successful? Why won’t this latest announcement from Apple revolutionize healthcare? I have a few theories”

I think the simple answer to that is that Apple has the trust of a hundred million plus people and has a system that lets them share with Apple what they’re doing with the most personal electronic device that they’ve ever used.

“First, access to medical records is just not that compelling for the average consumer. Think about it. How many times do you wake up in the morning and feel the urge to check your medical records? Don’t get me wrong. It should be an imperative to have easy access to important personal health data, that you can simply and securely share with your healthcare providers, or access in an emergency. I have long been a vocal proponent to giving individuals access to their personal health data”

I am lucky enough to work with Doctors who have been sharing medical records with Patients (the parents of some of the sickest children) for +30 years and my conclusion is  that the situation today that makes it difficult/impossible for Patients to access Health data exists because the sickcare industry is threatened by sharing and they’ve misled Doctors into thinking it’s value for Patients isn’t significant.

We have a classic chicken and egg situation because only once Patients get access to their data can services be built that add value.  In 2018 we have the Royal College of General Practitioners claiming that there’s no value to online access to Doctors but give 10 NHS Patients/Carers access to their NHS record and just watch how many mistakes and misunderstandings they’ll be able to point out, start counting the number of things that can now be talked about, look at how much more productive a relationship can become…

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No one would be at all surprised if an orchestra was terrible if it’s members were all signing off different music sheets and some hard no music sheets at all, so why is it any different when we’re talking about decisions and communications that are being made around personal information that isn’t being shared with Patients and Carers?

“But that leads me to my second point. Access to personal health records will not magically improve clinical outcomes, or even motivate individuals to better manage their health and wellness. As we now know from our work at Partners Connected Health, it takes a sustained, highly personalized experience, seamlessly imbedded into our daily lives, in order to change behavior that can lead to better outcomes. Knowing my blood pressure results from my last doctor’s appointment six months ago will not motivate me to take a walk after dinner.  We must not think that access to health records will automatically lead  to improved health outcomes”

This is classic group think. Because I can’t imagine the future of healthcare in our hospital means no one else can build it.

“My third caveat is that, while this is a very worthwhile advance for Apple users, but what about those committed to devices that run on an Android operating system? According to data from Gartner, in QI 2017, 86% of smartphones sold worldwide ran on Android. If we are going to make personal health records available to consumers, we must make it device agnostic in order to create real change.”

I think this is interesting but aren’t we all aware that every single unique mobile phone design and application has been copied exhaustively?

We know that nearly all those Androids have a touchscreen and app store that works like the one that Apple launched on the incredibly expensive iPhone 10 years ago. So why if Apple Health Record is a huge success wouldn’t Google and device makers copy it and offer it on the Android operating system? Why wouldn’t Apple give it away or make it available on Google Play (eg. just like they make Apple Music available to Android users)?

Then again perhaps Apple Health Record won’t work on Android operating systems because so many of them have been forked by the device manufacturers and mobile operators and Apple will get the Healthcare partners to subsidise/gift Apple devices to their Patients/Carers? Have we already forgotten that this is what they got the Mobile Operators to do to the tune of +$100 Billion?

“I suggest that we more closely examine how Apple’s new Health Records feature is actually different from past attempts.  It will likely be much easier to set up than Google Health or HealthVault and anything on a mobile platform is immediately more accessible. Apple also has their wonderful consumer design capabilities to bring to the party.  Undoubtedly, they will talk about those instances where an individual whose home is in Massachusetts breaks a leg skiing in the Rockies and is able to present her health record to folks in the Denver emergency room.  This is progress”

I think analysts are underestimating the opportunity Apple have because they have full end to end control of the system (unlike Google have with Android that might run on a device manufactured by Samsung and sold/subsidised by Verizon). If they can controversially put a U2 track on customers phones why would they need to make customers have to jump through set up processes. Next time you update your iPhone I expect Apple Health Records will just be a native part of an iPhone (fulfilling a prediction of mine that Health will soon just be another thing we do with our mobiles).

“There are just so many other problems that providing access to medical records don’t solve.  Medical record data is not that compelling from a consumer perspective.   If they bring something to the table that inspires consumers to care (and Apple knows how to do this), that could be transformational”

I’ve found lots of Doctors mistakenly think statements like “Medical record data is not that compelling from a consumer perspective” are valid. It’s consistent with thinking that the medical record access breakthrough is when “an individual whose home is in Massachusetts breaks a leg skiing in the Rockies and is able to present her health record to folks in the Denver emergency room” (>80% of Healthcare resources go on chronic disease care).

Firstly Apple is talking about ‘Patients’ and not ‘Consumers’ and it’s important we all appreciate the difference.

The lines are blurred so I really hope that Apple is going to put some effort into helping educate Patients and Carers on the difference between being treated as Patient and as a Consumer. If you consider “Consumers” as “persons who purchase goods and services for personal use” medical record data is clearly financially very compelling (and profitable). Look at the “free” helpline industry that has sprung up as Google shares medical information with referral agents and you’ll quickly realise there are $billions of short term profits to be made by corporations who treat Patients as Consumers eg. in terms of a ‘compelling offer’ a corporation like Google could probably give these ‘consumers’ free* mobiles in exchange for all the kick backs that they would make by selling on their personal information to others.

Medical record data from a Patient perspective is invaluable.  Of course it’s presence on your always carried mobile won’t make you lose 50lbs of fat overnight or help you with a mental health concern but the services that it’s availability will enable Apple to support will help motivate a Patient who is overweight to start sharing their concerns (they won’t for example fear the judgement many obese people feel they face when presenting overweight to a clinic) or mental health concerns (eg. you’re not going to have to pay to endure a conversation with a stranger who has no idea why you’re sat in front of them).

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New mothers to be offered NHS counselling by Skype to tackle post-natal depression

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Laura Donnelly, Health Editor at the Telegraph reports on how new mothers will be offered counselling by Skype under NHS plans to tackle post-natal depression.

“An estimated 140,000 mothers each  year – one in five – suffer depression, anxiety and other mental health problems during pregnancy or in the months after their baby is born. But thousands do not get support, with suicide the leading cause of death in expectant and new mothers.”

There are clearly lives being lost because of the failure to innovate in the delivery of healthcare services (suicide is now the leading cause of direct maternal deaths within a year after the end of pregnancy) but it’s even intolerable to think of the resources being wasted by the NHS through the continued support of the office-visit-only care model and GPs who have implemented a “One Problem Per Consultation” policy despite the evidence showing it’s no more expensive to help Patients share their own concerns using the tools of our time. How many of these 140,000 mothers aren’t sharing information about their mental help with a Doctor because when they get an appointment with a Doctor they prioritise the needs of their child or a physical health concern of their own?

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How many of these 140,000 mothers aren’t accessing a Doctor because it’s not convenient?  How many of these 140,000 mothers aren’t seeking time with a GP because they think/know they’ll go through the rigmarole of sorting the child care etc and just end up trying to explain their uncertain feelings in a rushed meeting with a stranger?

“Last year a report from the Royal College of Obstetricians and Gynaecologists found that 81 per cent of women said they had experienced at least one episode of mental health problems during or after pregnancy. But just 19 per cent were referred for any form of help, with just  7 per cent of women sent to a specialist…  …And a national audit of maternity care in 2016 found that 43 per cent of areas provide no specialised mental health service.”

I wonder how long it’s going to take until we accept that it is normal for women to experience a mental problem during or after pregnancy? I wonder how long it will take the NHS to realise that these mothers can use mobile phones and that this can help tackle the geographic access problems (like a major trauma centre has been doing with Facetime since 2012).

“The schemes, offered to at least 3,000 pregnant women and those who have recently given birth, are part of a £365m national plan to offer support to 30,000 women by 2021. Under the projects, NHS bodies will be expected to open “community hubs” for new mothers, offering them advice, referrals to specialists,  links in to other care agencies and groups for new parents”

It’s so bizarre that while the NHS is privatising core services and talking up using Robots to care for Patients it’s incredibly slow to realise opportunities to co-develop services eg. instead of opening new places why aren’t these ‘community hubs’ taking advantage of the existing community hubs that exist across the country already (eg. in GP Clinics, adult learning centres, schools/nurseries, etc)?

“Claire Murdoch, director of mental health for NHS England, said: “With so many new mums having the joy of motherhood interrupted by mental ill health, improving care, investment and focus on this issue, is crucial. “Falling pregnant and becoming a mum is a hugely emotional experience, so having expert support available, including working with people’s partners as well as their wider family and social networks, to help manage the upheaval, means that women who are experiencing mental health issues don’t have to suffer and struggle alone. “The new funding follows a £40m investment since 2016, aiming to bring help to more than  6,000 new mothers receiving access to specialist mental health care by April 2018.”

In the absence of services from NHS England I wonder if there is another huge industry of online referral agents masquerading as ‘free helplines’ like the ones that have sprung up to help addicts that legislation could stamp out?

“Last  week the National Childbirth Trust called for improvements in post-natal care, after a national survey by the Care Quality Commission found 72 per cent of new mothers did not see the same midwife after leaving hospital. The survey found 23 per cent said the midwife did not appear to be aware of their medical history, or that of their baby.  Less than six in ten mothers surveyed said they were “definitely” given enough information about emotional changes they might experience after birth, with a small drop in the numbers given a telephone number for a midwife or midwifery team they could contact”

I wonder why the NHS hasn’t yet issued a statement about how it will support Apple’s Health Record so that these Patients can have access to their record and are able to share it with carers?

“Mums net founder Justine Roberts said: “The perinatal period can be stressful and demanding, and women who are affected deserve prompt and compassionate professional care. “When we asked Mumsnet users who had recently given birth about their experience of postnatal care, they told us that mental health services needed more resources and a greater focus – so it’s great to see these funds being made available for this vital aspect of women’s wellbeing.”

It surprises me that Mumsnet founder would be so positive about resources being committed to fund NHS bodies “to open community hubs”. Can you imagine the resource Mumsnet Limited could create with just a tiny fraction of the £365m national plan’s budget?

Related Posts:

The opportunity to work with Patients online requires more than just Video/Skype calls.

mHealth & Pregnancy: From SMS to Apps & Beyond what are the opportunities?

Why do Mothers ask strangers in Facebook Mom Groups when they could waste everyone’s time & visit the office of a Doctor who doesn’t even know why they’re there?

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What if Amazon ran a hospital?

A colleague sent me this thought experiment by Dr Bertalan Mesko and i think it runs as one of 2018’s worst ideas.

I of course see no problem in Hospitals USING Amazon to become more operationally efficient but a few weeks ago I got a tour of the Zuckerberg San Francisco General Hospital and Trauma Centre and the $75Million bit of corporate rebranding made me nauseous and washed away a good bit of the optimism that I have for the future of healthcare but the idea of a Hospital being run by the for profit tech/logistics giant is ghoulish.

Getting a tour of the Zuckerberg SF General Hospital

It’s not like we don’t already have enough big tech companies hoovering data worth billions out of public hospitals in exchange for a few free hotels/flights to senior staff or big Cancer Charities that the public trust getting caught using big data and private detectives to screw timely donations out of the families and loved ones of those effected by Cancer.

With a basic understanding of what Amazon does and every single thing a hospital should be doing it makes for an unthinkably unethical scenario when applied to the care of Patients. For example:

Amazon Prime

This model seems to be what the US Health Insurance companies have already perfected, once you’re invested you might as well use it right?

“Frequently Bought Together” and “Bought together”

Veterinarians already do this. Operating rooms will have the world’s slickest salesmen prepping Patients for operations. “While you’re having this polyp removed we could also syringe your ears, get our 5* rated podiatrist into do a bunionectomy, your genome read also suggests we should probably also remove your …… and we have a discount on that because a Clinical Research Organisation is looking to buy these removed organs”

Have one to sell

“Have one to sell” becomes “No problem if you can’t afford your care, you can always trade some blood, sperm/eggs, spare organs, etc”

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The largest product catalog in the world

Perhaps this will be the first hospital where Patients are outnumbered by Specialist staff?


Walk this way and feel welcome to knock yourself out with inappropriate diagnostic tests…

Product Reviews by customers = Service reviews by Patients

It should be obvious how bad this would be. The Surgeon who saved my life has some of the worst online reviews I’ve ever read. I cannot fault his skills and he’s recognised by his peers and staff as one of the best in the world. Most of his work is on Patients who are family and friends of Medics who have the knowledge and experience to judge him properly.

Amazon 1 click ordering

Image the Doctors saying: “I’d love to give you more time to consider this but the system is sort of designed so that we have your ultimate decision in the next 20 seconds, so thanks for being so obliging…”

Search Results

Amazon has perfected search engine optimization and getting media headlines with drone delivery demos. It will be obvious that this Hospital is going to be the best hospital in the world if you read anything on the first million pages of an internet search or in any of the print publications that are owned by the corporations Billionaire mates…

Instead of running a Hospital wouldn’t it be better if Amazon focused on trying to help us move beyond the Hospital? Or followed Apple’s direction and tried to help Patients measure the value of the healthcare they’re getting (Amazon do a great job of doing something most hospitals would never do – list their prices!)?


Related post: Are the world’s biggest Pharmacy Retailers about to be Amazonised?

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Lecture Notes: How would the BornMobile generation redesign Medicine & what’s the future role of the Doctor?

Bookshelf of the Future

In March I’ve been asked to provide two lectures to the students at one of the world’s best medical schools. The title of the first: “How would the BornMobile Generation redesign Medicine” and the second “The future role of the Doctor”.

I thought it would be helpful to share my working notes for the lectures. I’ll then update this post with the slides and then (with agreement of the University) hopefully a video of me giving the lecture.

If you have any ideas/suggestions please add them in the comments or by sending them to us in an email.

How would the BornMobile generation redesign medicine?

Introduction (who I am, why I’m giving this talk)

Why it took me 20 years to work out that the person who taught me the most at medical school was the Parent of a sick child.

How the BornMobile generation brought up with a poster of a “Tesla Roadster in space” on their bedroom wall redesign healthcare (VIDEO DEMO)

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Comparison of ‘What do we all hope and want to do (our visions for what could be)’ and ‘What Doctors today are being made to do today (AKA the status quo)’.

Examples of how medicine would look if you applied Mobile First design

Call to action: what you can do today.


The future role of the Doctor

Introduction (who I am, why I’m giving this talk)

Comparison of ‘How Doctors work today (AKA the status quo)’ and ‘How we  want them to care for our mothers and children (our vision for what could be)’.

What skills and experiences are we going to need to develop and prioritise

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