ME and Ophelia

Monday, May 10, 2004

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Trainee doctors could diagnose patients online

American blogging doctor Nick suggests a great idea: in certain circumstances, patients and doctors could converse by email -- and trainee doctors could handle the replies (after the content is reviewed by the doctor).

Nick says that for doctors, answering emails seems like an attractive job to delegate to medical students. It would give the students the opportunity to take their time with diagnosis, consider triage, look up potential treatments and check against the hospital formulary, etc. These are skills trainee doctors have to learn anyway -- it's a lot more stressful to do when the patient is in front of them, with a full waiting room to boot. He feels the students would be more likely to write a longer, more thorough workup -- and one the patient could understand.

There are times I'd prefer talking to my GP or consultant via email.

Here in England, GPs are generally allowed 15 to 20 minutes with each patient. Someone told me that over the past few years this has been officially reduced from twelve to seven minutes.

Some GPs practices are like conveyor belts, especially on Monday's or when its raining. I noticed this when I first became ill in 1999 - on foul weather days the surgery was packed but on hot sunny days the waiting room was almost empty. Monday's were packed with a younger crowd, probably needing sick notes for their employers. Friday's were less packed.

For patients and staff, crowded waiting rooms can be stressful. Especially when a doctor is running late. People coughing and spitting, like they have flu or something else that's catching.

Attending a doctor's surgery can be a major project when you are feeling very ill. Getting organised, bathing and dressing for the outdoors. Hauling yourself out into the rain or snow during winter time. Traffic. Parking. Walking. Reporting to Reception. Waiting for your name to be called. Sorting out in your mind what to say when you see the doctor. It's such an ordeal. Makes it even more difficult to think straight. And can make patients feel worse because by the time they've sorted the prescription they've been handed - and get home - a ten minute face-to-face with a doctor may have taken up to one half day to achieve. Because time is short on face-to-face appointments, the doctor invariably recommends a follow up appointment in two weeks time. And so it goes on...

Unless it's an emergency, I'd never consider phoning my GP because he'd have a waiting room of patients and my phone call might upset his schedule. After a face-to-face consultation, it's not always easy to recall what's was said. Conversing with my GP via email would help me focus on explaining the problem, and make me feel I had every opportunity to explain things properly. I'd have a written record of my email and his reply. Our emails would be conveniently filed away in my computer for next time - and for future reference.

Sounds great for the patients with computers (who do not need a physical exam or tests). And sounds like a great way for medical students to train. By handling the incoming mail for doctors (as long as the doctor endorsed the final copy) it reduces the pressure on the GP who can spend more time on reducing face-to-face consultations. Sounds like a win-win for everyone involved. Much more efficient too. Probably would save on resources that could be spent on providing more doctors and nurses - so that everyone is less stretched, pressured and stressed.

Here in the South West of England GPs still make house calls. A few years ago, I needed my GP to provide an up to date report on my health. I phoned the medical centre (where he is one of several GPs) to say I could not get there for an appointment. They said not to worry he would come and see me. And left it at that.

Next morning around 11am there was a knock at my door. There he was standing, dressed in a jogging jacket, with a stethoscope around his neck and a bunch of patient files in his hands. No black bag or anything.

Parking is near to impossible here so he arrived on foot. And must have visited other patients in their homes around this area because he had more than one file in his arms. He stayed more than half an hour and got to meet Ophelia and see my view overlooking the seaside.

It was a nice sunny day, not too much wind. On his way out, I could hear someone in the road down below, waving to him and shouting out thanks to him for everything he had done for his wife (who'd died from cancer, the week before). The backdrop to all of this was a massive expanse of blue sea and sky right to the horizon - and Ophelia...

# posted by Ingrid J. Jones @ 5/10/2004
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