Ringing in changes to general practice
One of the most dramatic consequences of the coronavirus pandemic is that it has produced a shift to consultation by telephone in general practice, at least, as the first stage of contact between doctor and patient.
It is nearly 150 years since Alexander Graham Bell invented the telephone – it is amazing that it has taken so long for it to become fully accepted in the doctor’s surgery.
Until recent decades, many patients did not have telephones at home and doctors tended to scorn telephone consultations as a lazy substitute for direct contact. The advent and almost universal distribution of the mobile phone now threaten to render the traditional consultation obsolete. I hope this will not happen.
One is confidentiality. Many patients do not have a room of their own from which to conduct intimate conversations. It is often not clear who is listening – family members, nosy visitors, perhaps even an abusive partner. I have been obliged to consult with patients on the bus, train or in the office. Another problem is that the very immediacy of the encounter deprives the patient of time for reflection and consideration provided by the ritual of making an appointment and sitting in the waiting room. By the time they enter the surgery, they have had the opportunity to turn the problem over in their mind and think about the best way to present it – to the benefit of both doctor and patient.
The telephone offers one-to-one encounters. But patients often come into the surgery with family members, friends, partners who may provide valuable insights into the presenting problem as well as support. Greeting the patient in the waiting room offers opportunities to pick up on non-verbal cues, all invaluable aspects of the consultation.
When the coronavirus crisis recedes, I hope we can return the telephone to a more subservient role in general practice.
Vulnerable lose out
Who’s listening? I have been obliged to consult with patients on the bus, train or in the office
In one of his early coronavirus press conferences, Boris Johnson emphasised that the Government’s response to the economic impact of the pandemic would not be confined, as in the 2008 financial crisis, to rescuing the banks, but would give priority to the needs of the people. Hence the proposals of the Coronavirus Bill to suspend the responsibilities of local authorities to provide adult social care under the Care Act 2014 have provoked outrage among organisations concerned with the welfare of those with autism and learning disabilities, dementia and severe mental illness.
Speaking in the House of Lords, Baroness Tanni Grey-thompson, the former Paralympian, described the proposed legislation as “a health and social care obliteration bill by another name”. In our local authority, Haringey, in north London, 17 adult social care provisions, including several day centres, have been closed over the past 10 years. Even before the impact of Covid-19, options for families were very limited.
Now it seems that the vulnerable adults who have been hardest hit by a decade of austerity are once again being forced to bear the burden of a social care crisis.
Self-isolation in 1665
Reporters are beating their way to the Derbyshire village of Eyam, where residents, led by William Mompesson, their courageous vicar, famously self-isolated to confine an outbreak of the plague in 1665. Though more than 300 died, they succeeded in preventing any wider transmission. As a schoolboy in nearby Sheffield in 1966, I well recall the tercentenary commemoration of this event.
Elizabeth Hancocke buried her husband and five children within eight days, leaving this inscription on their grave:
Remember man, as thou goest by, As thou art now, even once was I, As I doe now, so must thou lye, Remember man that thou must die.