Jim* looked at me with a big smile on his face while his son adjusted the iPad and joined him. Like many elderly people, he’s very frail and finds it difficult to get to the GP surgery.
As his doctor, I’d traditionally have done a home visit, but with travel time and other duties, I’d barely be able to fit one appointment in. That morning I had six video calls booked.
Jim’s son was worried about his dad’s memory since the pandemic began, and the fact he didn’t want to leave the house.
Around 10 minutes into the call, we completed a memory test. Jim had drawn an immaculate picture of a clock face, and scored 100%. It was clear to me that Jim wasn’t suffering memory problems; it was more likely he was depressed.
Scanning the room on the video call, watching his face flicker and respond to cues, I’d seen this too many times before. ‘Do you want to come in next week?’ I offered. ‘Nah, can we do this video thing again, it’s much better.’ I booked him in and hung up.
Gone are the days of people sitting in the waiting room, wondering who’ll be called next. As lockdown eases and life gradually returns to normal, most GP practices have increased the number of in-person appointments.
But because of Covid-19, we’re a little more organised, and we now have a range of appointment options available. With a variety of communication methods on hand, there’s little need to default automatically to ‘walk in’ appointments.
Often, it’s not what patients want.
GPs never stopped seeing patients during the pandemic, including in-person. For most of us, the overall workload increased.
During lockdown in March last year, there was around three months of eerie quiet. Then towards the end of June, a steady trickle returned, which became a stream, then a river, then… well, put it this way, it was a storm in the Atlantic by mid-September.
It was all telephone triage then. Feverish patients were sent to a Covid-19 hub, with a handful of patients seen in-person each day. Video calls became an important step.
I have assessed patients with Covid-19 over a video call, so they could safely recover at home
It seemed strange not to see patients in-person, but our sick, vulnerable and elderly patients were dying. The wrong person in the building could infect staff and vulnerable patients, and digital care was a necessity.
We are now – touch wood – through the worst. But things are not going back to how they were, and neither should they.
For some conditions, in-person care with a doctor in the room remains the most appropriate option. But the situation is not black and white. Digital and physical healthcare can work together, and well.
Before the pandemic, video consultations were only offered by a few enthusiastic trailblazers, but they have now become part of the fabric of general practice.
Digital tools have changed how I consult, with fewer time-consuming home visits, but most importantly it’s supported people to take charge of their own conditions at home. Blood pressure monitoring is now mainly managed this way – my patients usually have better things to do than hang around a GP practice.
For me it’s still about what’s best for the individual – if they want to come into the surgery, we are open with safety protocols in place. If they prefer the convenience of video consultations, we’ll accommodate that, where appropriate.
I have assessed patients with Covid-19 over a video call, so they could safely recover at home. Video consultations have also enabled my less-mobile patients – who may have had to wait longer for a home visit – to be seen more rapidly; GPs can do four to five more video calls in the time of one home visit.
For one day of my five days a week, I now work from home, my dog asleep by my feet. Without this option, I would be facing burnout, no question.
I’ve felt the pressure this year and believe the British Medical Association’s report, which suggests a third of GPs are considering retiring in the next 12 months. I was nearly there myself.
I remain convinced remote working via video consultation helped me fall back in love with general practice.
Ultimately, I believe we need to ask patients what they would prefer. Patients like Jim.
He’s started going to his bridge club again and his son got him an iPhone, which he can’t put down. Jim’s even requested to follow me on Instagram. He’s clearly a digital convert.
*Name changed to maintain patient confidentiality