GP appointments by Skype are both immoral and stupid
Iwoke up one day last November with the feeling of wetness on my ankle, even though it was dry. As someone with pretty bad health anxiety, I was immediately disconcerted. Things got worse over the next few weeks, with feelings of intermittent freezing and burning accompanying the odd wet patches. Panic ensued after an ill-advised Googling of the symptoms, and I became convinced I had a terrible neurological disease.
I arranged a Skype conversation – intended to be reassuring – with a neurosurgeon friend of the family. After listening to my symptoms, he advised me to get myself seen to pronto. When the GP told me it would take four months for an appointment with a neurologist, I decided to pay through the nose to see one privately, and was mightily relieved when he dismissed the possibility of anything sinister being at play.
Interestingly, when I saw the neurosurgeon in person at a social event two weeks after our anxietyinducing call, he too dropped all the concern he had expressed on Skype. I looked, he said, the picture of health. The difference between our electronic and real-life meeting was fundamental. Over Skype, I was a list of symptoms resembling any number of dreadful conditions. In person, I was a healthy and vigorous-seeming woman with nothing wrong – except my neurosis.
So much of the information doctors rely on comes from seeing patients in the flesh, where they can observe nuances of movement, gestures, skin, and – crucially – prod you. Which is why my hair stood on end when I read last week of new money-saving proposals for the NHS – part of its nightmarish-sounding “service redesign” for the digital age. I was particularly horrified to see Theresa May, along with a number of health chiefs, proudly announcing a vision of a brave new world in which 90 million outpatient hospital appointments would be conducted over Skype, rather than in person. I can see why you could Skype your lawyer or accountant. But your doctor? Meddling with the single most important tool of medicine
– the physical examination – would be as immoral as it is stupid. Reassuringly, medical experts were quick to point out the foolishness of the plan, but it is still terrifying that such an idiotic proposal could be presented smilingly in public.
Terrifying, but hardly surprising. The idea clearly came from the same place as all the worst NHS ideas and targets have in recent years: management in cahoots with politicians.
Simon Stevens, chief executive of NHS England, boasted that under the digital service redesign patients would be able to “access advice at the touch of a button”. But Mr Stevens, like many of his colleagues, has an MBA, not a medical degree.
He and his ilk should probably spend more time with actual doctors and patients rather than strategists and politicians. It might remind them that people don’t want to access advice “at the touch of a button”. They want to be seen, in the flesh, by a human being, just as more and more people are shunning self-checkout machines in shops for the pleasure of going to a manned till.
The Skype idea, along with others put forward to advance the promised NHS digital revolution, has management objectives, not medical (or even human) ones, written all over it. The NHS is groaning under the weight of its 35,000-plus managers. A major survey by the BBC last year found that the health service now recruits them faster than nurses.
But no amount of managers can save a system with chaos at its core. And who can now pretend that the system isn’t broken? I kept faith in the NHS until recently, but – like almost everyone I know – can no longer ignore the relentlessness of bewildering oversights. I have been turned down for the service’s muchvaunted CBT therapy for help with chronic insomnia because I wasn’t suicidal enough. I’ve had duplicate appointment letters sent out with different times and dates, and promised follow-up letters that have never arrived at all.
A friend of mine was told she’d need to wait five months for a spinal scan, information gleaned only after she called two different appointment lines four times, with each referring her back to the other. She was told gruffly on the fifth attempt that it was her job to chase her appointment through what had become an amazingly complex labyrinth. I shuddered along with her to think of how a less confident, elderly or simply a far less well person would cope in such a situation.
Then there are the weird psychological effects. We’re all finding ourselves apologising to the GP for troubling them, embarrassed to impose – despite paying our taxes – when we know how under-resourced the service is.
It’s impossible to deny any more that the jig is up. This is simply not a First World health service. It is an unnavigable, random-seeming system, with patients at the mercy of endemic opacity and confusion.
The NHS, they say, is a religion. But it isn’t a religion; it’s a First World health service that no longer behaves like one. It’s time for a rethink. We probably need more privatisation, or at the very least, a top-up fund similar to the TV licence to help secure not more managers but more doctors, hospitals and drugs.
But until the delivery of first class medicine becomes its priority, this evangelism is going to cost NHS patients – more than it already has.
It’s impossible to deny that the jig is up. This is simply not a First World health service
Digitise: the health secretary Matt Hancock wants more outpatient appointments to be held edo over e S Skype ype