Friday, August 28, 2015

The Former ACHI President Makes Some Sense On Doctor-Patient Interactions And New Technology.

This appeared as an opinion piece last week:

Opinion: GPs should use technology to their advantage

18 August 2015
SO MANY things now no longer need physical human interaction. You can organise a loan without visiting the bank. Accountants, lawyers and other professionals rely heavily on electronic communications.  
What does this mean for the medical profession? Why do we still insist on seeing people? 
I am not advocating we no longer see patients face to face (f2f), merely that we can be more efficient by not doing so for much of our work, and still be just as effective (from both technical and relationship perspectives). And this doesn’t necessarily mean Skype.
Online tools for mental health are well received by patients and show positive outcomes, yet:
  • I can’t routinely book my doctor’s appointment online (specialist or generalist).
  • I can’t email my doctor with a simple question and instead must lose an entire morning sitting in the waiting room.
  • I must play telephone ping pong with my providers. 
Funding plays a role yet, in a workforce-limited world, inefficiencies abound. In one 15-minute f2f consult time, I could probably deal with four email consults: your cholesterol level is okay; no, you don’t need to come in unless it doesn’t improve by tomorrow; I’ve got the test results; you can take the antibiotics. 
The problems aren’t technological, they are cultural. Yes, a lot of healthcare requires human interaction and to lose that entirely will be for the worse. Yet some myths have been built up around this and they are worth puncturing. 
The first is privacy. A great deal of effort has been spent trying to ensure electronic communication is encrypted, and the RACGP recommends all electronic communication be so. Yet unencrypted email remains more secure than both letters (which can end up in the wrong mailbox) and faxes. Although there are risks that electronic information can leak, similar risks occur with paper records. So while encrypted email is a gold standard, there is little risk with unencrypted communications. 
The second is that f2f interactions are central to understanding the patient and providing high-quality care. Built around this is the assertion that, unless you can see the patient, you aren’t ‘‘seeing’’ them. Yet quality care may include not having patients sit in the waiting room during an influenza epidemic. With the demise of home visits, GPs have distanced themselves from communities. Whole-person care relies on understanding the patient in their social context, so doesn’t that include Facebook these days? 
More here:
The call for a little more pragmatism and flexibility in how health care is delivered and to make the most of available and widely used tools is just common sense and should be supported. The resistance to simple and safe ways of doing things is really very hard to understand - other than to point to bureaucratic inflexibility and vested interests.
Worth a browse and please comment with your views.

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