Dr Arun Ghosh
There is a case from the pandemic that will always stay with me of a man given appointments remotely. He was 24 and suffering from lower-back pain after exercising.
He was given a telephone assessment, and a colleague gave him ibuprofen and told him to rest. When the pain continued, again he booked in for a telephone call, and this time he was referred to a physiotherapist.
This young man had myeloma – a type of bone marrow cancer – which was eventually picked up late because he hadn’t actually been physically examined for almost six months.
I often think if he had been examined in person sooner, the doctor might have seen this was more than a simple back injury. Technology can work well for younger patients who need something straightforward, such as emergency contraception.
But my concern is that it really isn’t a replacement for a hand on the tummy or listening to someone’s breathing. As a junior doctor, you are taught to take a history of the patient’s symptoms, do a good examination, and then come up with a diagnosis.
On the phone, you can only really take someone’s history, and they may not think to tell you the most important symptoms – plus they only have a few minutes to tell you about it, as these appointments are generally shorter than face-to-face ones.
Even with video consultations, I often think afterwards, could I really be confident I had seen an infected insect bite, or was it a blood clot? Many GPs, especially locum doctors, now prefer remote appointments. They get paid to sit in their own home, which makes it easier to deal with family commitments.
On remote appointments, you can only really take someone’s history, and they may not think to tell you the most important symptoms, writes Dr Arun Ghosh
But there are good reasons for face-to-face appointments. In a surgery a doctor can see from a patient’s medical records that someone hasn’t had their flu jab, or their child hasn’t had their vaccinations.
I also worry about the domestic abuse cases, where anxious women would repeatedly come in with children who had minor illnesses. We would ask questions about how they were coping, and then discover what was happening at home. But that is much harder to do on the phone or online, when they are speaking from home.
With phone appointments, there is also a risk that calls won’t be answered. And there is the importance of trust, now that most patients aren’t able to see the one family doctor they have had for years.
If a patient doesn’t feel the GP is really paying attention – often they can hear you typing as they talk – they may not provide all the information on their symptoms.
I want to embrace technology, but as a doctor who has been doing this for 20 years, I think face-to-face appointments are very important, particularly when it comes to mental health. Just seeing a patient in person, and reassuring them with a physical examination, can remove a burden they have been carrying for weeks.
Dr Arun Ghosh, 42, is a GP partner at Ghosh Medical, a private GP service run in Liverpool and across the North West.
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