THESE days you can get health information and advice from any number of sources, such as pharmacies, the internet, charities, newspapers, magazines, books – and maybe that nice neighbour across the way.
But there’s one thing you can’t get from Dr Google or any of these places. A physical examination.
Uniquely, doctors — and often other staff such as physios and nurses — assess what’s wrong by examining someone in a tried-and-tested, scientific way.
That’s why face-to-face GP consultation should be the norm.
As a student decades ago, I was repeatedly warned of the perils of treating a person who wasn’t in front of me.
Call me old-school, but that’s also the advice I’ve been passing on to my medical students for more than 15 years.
If you don’t look at the patient properly, you are not even in a position to make a diagnosis.
Then Covid-19 erupted and life got complicated.
When the pandemic was declared in March 2020, medics had to adapt quickly.
The NHS itself gave the advice to assess or triage all patients remotely before considering seeing any of them in person.
In early March last year, Dr Nikita Kanani, NHS England’s medical director for primary care, wrote to GPs recommending telephone or video appointments to avoid patients having to come into surgeries.
It was good advice for the time. The entire population faced a potentially lethal infection for which there was then no vaccine.
I dread the prospect of remote care becoming normal
Worse, there was a dire shortage of personal protective equipment (PPE).
It benefits nobody when doctors and their staff have to go off sick.
Some never return after catching Covid, not because they are lazy but because they are dead.
More than 40 doctors and hundreds of our other health workers are known to have died with Covid.
The real toll is likely to be much higher, because not all of these deaths are made public.
Now, 18 months on, Covid hasn’t gone away but we are in a more stable situation. It is also easier for practices to get PPE.
Worse, there is a backlog of sick people who haven’t had ideal care. This is not just my opinion. Waiting-list figures speak for themselves.
There are mutterings that some people might still be with us had they been offered in-person appointments.
A coroner has even mentioned six deaths that might not have occurred.
The General Medical Council and other bodies have offered guidance on providing safe and effective consultations by video or phone.
But that doesn’t mean virtual consulting is as good as face-to-face, or that it should form the template for all future care.
Some patients have embraced remote care. It has saved them contact with potential sources of infection and it seems ideal for those stuck at home or elsewhere.
If you are at work and you just want some routine advice from a GP who has your medical records, it can be preferable to taking time off work to go to the GP surgery.
But I believe virtual care is always going to be second best.
To give some examples, a new skin condition, knee pain or visual symptoms can’t be properly assessed.
Even with video, there is no eye contact and precious little body language.
And just imagine trying to comfort the bereaved in that scenario.
It is impossible to pick up subtle clues or engage in that quiet listening that helps understand the whole situation or encourages someone to voice what is really concerning them.
Instead of unearthing a hidden problem, the consultation can end leaving loose ends and “unknown unknowns”.
The rise of domestic violence during lockdown makes it even more vital to provide people with a safe space to share their problems.
This can’t happen when the aggressor listens in on a phone conversation.
In any case, remote appointments are impossible for those without phones or online access, and for many other people who are already disadvantaged and face more ill health than most.
I’ve worked in a practice with a total telephone-triage system.
Yes, it could be a plus for someone with sudden chest pain or suspected stroke symptoms if they could be directed straight to hospital.
But for many, many others it seemed to delay a full assessment. Talking to colleagues since, I realise I’m not the only one who thinks so.
Can all GPs now provide a full face-to-face service? At the moment they probably can’t, because we are not out of the woods yet and there are many serious staffing problems.
General practice is the first port of call for most people with symptoms.
Often it is the only port of call. If GPs give false reassurance, or make the wrong decision, the outcome can be dire.
Only 57 per cent of GP appointments are now face-to-face. But remote care is a compromise, and I dread the prospect of it becoming the new normal.
In-person consultation is the gold standard. The Government needs to support it.
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