British Journal of General Practice 2020; 70 (698): 455. DOI: https://doi.org/10.3399/bjgp20X712445
In a 2005 novel by Michel Houellebecq, Daniel24, like his fellow humans, now lives out his existence in a small room with an internet connection that gives access to all his needs. Climate change and nuclear war have meant that this is all that is possible. He is the 24th version of Daniel who once existed at the turn of the millennia. In The Possibility of an Island,1 humanity has found a way to continue.
Uncomfortable echoes of our new work environment perhaps? It would be true to say that coronavirus has done a very good job of forcing our hand in regards to the technology that we already had available to us.
NO MATTER HOW FAST WE GO, IT NEVER SEEMS FAST ENOUGH
Video calling and online conferencing have proved remarkably adept at bridging the physical gap of needing to be together. In a world that values speed and time, we are seeing how efficient this technology can be. The behemoth that is the NHS craves efficiency to avoid overspend and unnecessary delay. However, increased speed comes with its own paradox; no matter how fast we go, it never seems fast enough.
But at what consequence? The first, and a regular conversation at our metre+1 coffee breaks is the loss of human contact. Many doctors enjoy the job because we enjoy the company of one another, the chance to meet new people and try to touch their lives. Yet communication is more than words, the other 55% of communication is the non-verbal information.2 How many vital decisions have been made by GPs based on a sense that something is not right, despite everything on paper looking correct and in order?
There is also the loss of the physical examination. Now our words must become our hands to remotely examine and our minds must then attempt to correlate this information. So much of the doctor–patient relationship relies on trust and this has been shown to increase when there is actual physical touch. I always thought it was interesting in embryology that ectoderm makes not only the nervous system but also our skin. Could our skin be far more than just a barrier to the elements?
Finally, the balance of the consultation has changed. Before the patient came to us on our terms. Now the doctor arrives in the pocket or bag of the patient. They could be anywhere, with anyone, in the middle of almost anything. How does this affect the authenticity of what they can tell us? How does this affect the denouement of the consultation? I had a patient the other day who very much sounded like he had an incarcerated hernia, yet he was currently on site as a foreman and one of the water pipes had burst during the phone call. When I told him that I felt he should make his way to see the surgeons, he resisted saying that he needed to sort out what was happening.
We stand at a fascinating and important juncture of healthcare evolution. Being state run the NHS will always value efficiency and the bottom line over anything else. But I feel we must be careful of the seductive siren calls of the technological revolution. Doctoring is many things, but what makes it the deeply special profession it is is the opportunity of a shared humanity, which is arguably as healing as any diagnosis, medication, or treatment plan.
The opportunities to treat more and more patients in less and less time is the unspoken aim of the improving of technology. But as we move into this future, we must continue to courageously ask both ourselves and our employers; is this really doctoring and who is really benefiting?
- This article was first posted on BJGP Life on 22 July 2020: https://bjgplife.com/doctoring
- © British Journal of General Practice 2020