In this Telegraph article I think Professor Maureen Baker, Chair of the Royal College of General Practitioners, adds to the confusion about the adoption of consumer technology by GPs so I thought it worth sharing my thoughts.
Healthcare Professionals need a lot more media training
Surely it’s obvious that you’re losing the battle when you’re responding in the Telegraph to the ‘Strike all you like Doctors Technology will soon replace you’ article that the same newspaper used to smear striking Junior Doctors?
If you need evidence look at the deliberately misleading social media quote in the margin of Prof Bakers editorial with the Tweet/Facebook share button that reads “Being the only people who know about our health has made doctors wealthy and important, so it would be understandable if they had reservations about technology that threatens to overturn their monopoly on medical wisdom“. It’s completely at odds with the editorial and shows to me that the RCGP Chair’s piece is being used here as little more than fodder for the Telegraphs media machine.
“Technology will never replace doctors – but they must embrace it”
I think leading with this statement undermines the entire article because GPs already do embrace technology that replaces the need for Doctors.
Every time a GP vaccinates a child they’re using vaccine technology to replace the need for Doctors to care for Patients who may otherwise encounter an illness. GPs I work with have vaccinated thousands of children and it should be reinforced by the RCGP Chair that these have prevented the need for lots of healthcare professionals eg. a good example would be the Polio vaccine technology that has retired the need for iron lungs in the NHS.
Where are the NHS GPs who aren’t already embracing vaccine technology?
“Would you rather find out you had terminal cancer from a smartphone app, or from a sympathetic and well-trained human being?”
I think it’s a mistake to use this example because it’s not really something GPs do (Oncologists typically share such news with Patients) and it’s likely to just frighten the hell out of the public from going to their GP with concerns if they think that this might be a typical thing that GPs are saying to Patients.
“I’m no clairvoyant, but the idea of technology replacing doctors – a topic raised by two articles in the Telegraph over the last couple of weeks – is not one I can see happening , or anything close, for a very long time if ever”
I think this is a really silly broad sweeping statement as clearly technology is replacing the work that Doctors do. Young mums rarely see their GPs with croup anymore because websites with useful information help them to manage it themselves without the need to go and visit the GP.
Smart GPs with informative websites (like Dr Amir Hannan who has NHS GP clinics in Greater Manchester) have gone to great effort to provide quality links to content that Patients can trust and act on so to say this technology isn’t helping Patients to self manage their care (as a replacement/substitute for going to a Doctor) is undermining exactly the type of technology adoption by members that the RCGP should be championing.
“One editorial went so far as to claim that GPs should be working harder in order to meet the growing demand of our ageing population. I’m not quite sure how. GPs and our teams are working harder than ever to deliver well in excess of 370 million patient consultations this year – upwards of 60 million more than five years ago. Yet the funding for our service in real terms has declined dramatically over the last ten years, and our workforce has remained relatively stagnant”
I think Professor Baker needs to read the AskMyGP GP Access Manifesto. I think that to win public support GPs need to stop measuring how much they do (ants are busy!) and start sharing how effectively they work to improve the health of Patients and get value for money from government healthcare budgets.
“We need more resources and we also need less red tape keeping us away from frontline patient care”
I think the RCGP has it’s own red tape issues that are adding to this eg. today I attended along with 100+ GP colleagues an online CPD webinar/course on Primary Care Management of Gout (GPs need to get 50 external points a year and get 1 point per hour of such approved/accredited study) and while I think it would be great if this was provided by the college it’s not because Pharmaceutical companies are now putting their marketing budgets into these and making them free for GPs to attend in exchange for the advertisement, permission to email, etc, etc.
The RCGP I feel is behind the times on this because their events almost all involve a charge and most aren’t available online and it’s a shame as there’s a stack of time away from the frontline being wasted by GPs travelling to and attending CPD meetings and this is a really simple area in which the RCGP should be embracing technology and showing leadership eg. making CPD content that GPs can use to take advantage of their commutes, time on the bike at the gym, etc.
“We also need the media to stop telling us to work harder when we’re already working ourselves to the bone”
I’m not sure that this ‘to the bone’ analogy works very well for the work GPs do. An increasing number of GPs work part time and Patients can immediately see the hours their GPs work when they go to the clinic or look at the clinics website. GPs do incredibly demanding work that is incredibly difficult but it’s not something that should be compared with hard labor and it’s not conducive as we all want higher standards for GPs (we don’t want them work to the point of mental exhaustion which comes long before physical exhaustion).
“As GPs, we are not resisting the use of technology. In fact we want to maximise our use of technology as part of a 21st century health service”
I think this should read “as GPs we are pioneers in the use of technology”. What other Professional with 7+ years of education and 5+ years post graduate training has used technology to such an extent that they can be available to you on the phone within 30 minutes without a charge?
“In many respects, general practice is leading the way in implementing technology in healthcare. We were the first service to introduce electronic medical records and now 97 per cent GP practices now also offer some form of online access to patients, be it the ability to book GP appointments, ordering repeat prescriptions, or accessing their medical records (something the College is supporting family doctors and their teams to implement)”
I think this is a hang over from the RCGP’s lack of vision and it highlights how important it is to stick to the facts to make a good argument eg. First Direct wouldn’t be able to call itself an online bank if all it provided to customers was the ability to book an appointment with a member of staff in a high street bank.
Booking a GP appointment is something that’s very helpful but you can’t call it online access to a GP because it’s just online access to their booking system. See AskMyGP for an example of what online access to an NHS GP really looks like.
“These services can be particularly beneficial for our growing number of patients with multiple complex and chronic conditions, for which our health service is not designed to deal with in such huge and rapidly growing numbers”
I think the RCGP need to make this point much clearer in their communications because this is what underpins the complexity of a GPs workload. The 2000 year old healthcare model is broken forever.
“Technology can also support patients to care for themselves, and help to foster active lifestyles – essential in order to keep general practice, and the wider NHS, sustainable whilst resources are so scare and demand for GP services is so high”
I think it should be made clear that ‘technology is already being used by Patients…‘
“Gadgets like Fitbits and Jawbones and other monitoring devices, and consoles like Nintendo Wiis, are already facilitating this, And the fact they are becoming so popular amongst a wide demographic can only be a good thing. But gizmos and gadgets can’t do everything”
“The role of a doctor is multi-faceted. It isn’t just clinical knowledge or use of data; it’s judgement, it’s communication, it’s diplomacy, it’s tact, it’s pattern recognition. Crucially, it is the ability to apply that knowledge and adapt it to suit the patient in front of you, within the prevailing ethical and regulatory frameworks. A computer or robot or algorithm might be able to do elements of this but not all. These days, people very rarely have just one thing wrong with them at any one time. Machines, no matter how good they are, are a long way off from being able to handle that complexity at the moment, and nor are they likely to. Fundamentally, no machine or programme has any “understanding” of the human condition”
I think the challenge is that people (mostly men) who advocate for technology substituting for humans in medicine often have little idea of what GPs actually do when the doors close and they’re in a consult room caring for a Patient. Once they’ve been peddled with the line that a GP’s job involves just linking together a few symptom checker outputs and picking the most likely diagnosis I’ve noticed it’s often hard for them to undo this belief.
Much more helpful would be to ask them why they don’t already use algorithms to choose/buy all their clothes and shopping and write their newspapers (they probably do going by the stock photo used for this Telegraph article!), why they don’t let an algorithm choose which property they live in and set their mortgage repayments, why they don’t let algorithm’s choose careers for their children find them a wife, etc. Failing that ask them to reflect on what’s wrong with this Digital Health Experience comic!
“In the short term, there are also patient safety concerns. We are all aware of the potential for human error but errors in technology can happen too. And, as yet, there are few safeguards for software in comparison to those in place for the drugs, devices and, yes, the humans in the system”
“Take apps, a growing market with massive potential. Kite marking isn’t readily available and the current medical regulatory framework for apps that are registered as medical devices is not fit for purpose for 21st century apps and the way in which technology is evolving. It is essential for patient care that apps provide correct, evidence-based information and that appropriate safeguards are put in place – there is definitely a need for some form of regulation”
Same applies to websites, nonsense you read in newspapers, celebrity diets, quacks, etc, etc. In 2016 it should be obvious that Communities Dominate Brands and helping the GP community to find their voice and speak up should be the focus of the RCGP because regulations just can’t keep up with the pace of innovation and the fact that information and opinions are now being shared globally in milliseconds.
Today GPs are prescribing apps and mobile connected medical devices (like glucometers and blood pressure monitors) to Patients (who think their meds and their apps are inseparable parts of how they manage their chronic disease) yet the RCGP has no mHealth course available for them to take (check out the one we developed for the Healthcare Informatics Society for the idea of what’s needed). Imagine the nightmare if people were allowed to prescribe drugs without pharmacology training?
“We also have concerns about the patient safety implications of apps offering virtual consultations via smartphones. Patients will be having consultations with GPs who are unfamiliar with – and won’t necessarily have access to – their medical history, or information about drugs that they have been prescribed. Medical histories provided by patients themselves will rarely be as comprehensive as those held by their family doctor. There are also many signs and symptoms that GPs look out for when making a diagnosis, that the patient might not think to raise. And a virtual GP cannot conduct a physical examination”
I think this highlights some very basic flaws in the RCGP’s understanding of the evolving role of the GP and the urgent need for the RCGP to introduce some specific training and advice and guidance for members. It should be clear that there is nothing virtual about consulting with a Doctor just because that Doctor is remote.
I also think it’s fanciful to argue that NHS GPs in their offices are always familiar with their Patients medical history as we know many work as chronic locums and there are enormous time pressures (eg. 5 min appointments where Patients are asked to book another consult to discuss another problem) for which they get no opportunity to prepare.
There is also an abundance of published evidence (eg. waiting room surveys) showing that Patients have information that they would readily share that they’re not getting the opportunity to share.
“So, in my opinion, technology will never replace doctors. But healthcare professionals should embrace it for the benefit of our patients and the future sustainability of our health service.”
I think this closing statement would’ve worked better if it had stated clearly something like: “Healthcare professionals should continue to embrace technology for the benefit of Patients and the future sustainability of our health service and in my opinion there is no sign that GPs aren’t continuing to champion for the appropriate use of technology so that they can further utilise the upper end of their range of skills”
Let me know in the comments below what you feel about Professor Maureen Baker’s article?
In the meantime here’s a hard and fast rule that you can take away: When Technology makes Doctors more productive the need for Doctors increases: