You’ve all seen the headlines about remote consulting, including ‘it’s the end of general practice as we know it!’ But, is that such a bad thing?
General practice has been unfit for purpose for at least 20 years. GPs have been leaving the profession in their droves, unable to do the job properly because of under-staffing and systems that don’t work for our ever-increasing populations.
The foundation of general practice has always been relationships. Building rapport with people who will want to come and see you again; who will trust you with their innermost fears and demons; and providing advice in a manner that speaks to their priorities and values and that forms a partnership between doctor and patient.
All our training in this highly complex skill has been with face-to-face meetings. Over the phone or in a virtual setting this requires a slightly different skillset, but building those relationships is just as important.
Connecting with patients
Telephone consultations are still consultations. You still move through connecting and summarising into handover and safety netting, it just uses a slightly different skillset. You can hear a smile in a voice, feel anxiety seeping down a phone line, notice despondency in tone, rate and rhythm and act on these cues. You can make listening noises rather than nodding, you can check the patient’s ideas concerns and expectations.
I feel more connected to many of my patients than I did before the pandemic, perhaps because of the flexibility, ease of access and variety of ways in which I can communicate with them. When I think to other important relationships in my life I can assure you that digital communications have only proven to enhance them. My mum lives 300 miles away, and while a hug from her would be fab, a video chat ensures our relationship remains as strong as ever.
The flexibility on our side has really helped my wellbeing. Now if I run late the only person I’m impacting is me. The housekeeping section of my consult can be completed without guilt. I go to the loo when I need to go to the loo, get a coffee when I need a coffee and manage to get away on time most days.
And because of this I find myself paying more attention to what patients are saying, encouraging them to open up about why they aren’t losing weight, what is stressing them and how this might be impacting their physical symptoms in a way that feels less imposing than in person.
Teleconsulting has opened the door to working from home and variable hours that allow for work to fit around other commitments. Working from home reduces the staff and patients actually in the building therefore cutting infrastructure costs and our carbon footprint.
When evaluating a change to our practice I try to use the quadruple aim as the centre point:1
- improving the individual experience of care
- improving the health of populations
- reducing the per capita cost of healthcare
- improving the work life of those who deliver care.
Many colleagues have also welcomed these changes positively.2 Certainly my patients seem to like it for the most part and we intend to send questionnaires to evaluate this more formally.
Measuring change to health outcomes may be trickier, but we intend to look at crude measures initially such as referrals, admissions and unexpected deaths. The cost of these changes will again take time to measure.
Every change will have unintended consequences, but that doesn’t mean we should go back. COVID-19 has highlighted and exacerbated health inequity. Digital solutions could exacerbate this issue due to lack of technology amongst deprived populations.
However, it is also a potential tool to help this. Clinicians working remotely can support under-staffed areas with both urgent and routine care, thus freeing up the GPs who are on site to spend more time on those with the greatest needs in their communities.
So overall I prefer to think of these changes as the start of general practice as I want it to be, not the end as we know it. Fit for the 21st century, with relational care at its heart, enhanced and supported by digital solutions, collaborative working and equity of resource by need rather than demand.
- Dr Katie Barnett is a pos-CCT fellow with Haxby Group Practice in York and an honorary clinical fellow in the Department of Health Sciences at the University of York. She is on Twitter @drkatiebarnett1 and blogs about wellbeing and fellowship at Thefellowshipmonologues.wordpress.com This article first appeared on Dr Barnett's blog.
- Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med 2014; 12(6): 573-576. doi:10.1370/afm.1713
- London South Bank University. 10 Leaps Forward – Innovation in the Pandemic. London; June 2020.