A final look into the future

This will be my last column for Local Matters.  I’ve been knocking out 400 words just about every month for four years, and frankly I’ve run out of things that are wrong with me so have no more material.    My editor has, trustingly, allowed me to traverse a wide range of topics and it seems I’ve had the strongest response when I’ve been open about my own experiences and challenges.   This reflects the fact that people want to know their doctor not just as a clinician but as a person.

 So, thank you to the people who liked what I wrote and told me.  Also thank you to the people who didn’t like what I wrote and didn’t tell me. I’m going to get out while the going’s good.

Since I’ve reduced my hours at Family Doctors, I’ve had time to think.  This can be both interesting and dangerous.  Interesting in the sense that general practice is changing rapidly, and we need a radical rethink about how to respond to this. As I said in a previous column,  the GP of the future will not be an individual but an combination of skills and services provided by a team and some technology.  Artificial intelligence will enhance patient care and safety. The distinction between doctors and nurses will blur.

And dangerous in the sense that I personally want to escape from patterns of clinical practice that are old-fashioned and energy sapping.  I did a little time-and-motion study on myself recently and the results were revealing.  In a typical week I worked 32 hours (plus eight hours at my other job -so much for going part-time) and out of that time I spent just over 16 hours in face to face consultation with a patient.  About an hour was spent teaching and supporting junior staff and the rest consisted of emails, phone calls, processing tasks and results and writing prescriptions.  This is not necessarily a bad thing because frequently patient enquiries can be dealt with remotely, which is convenient for everybody.  But the sheer volume of incoming information is staggering; over 200 test results and 140 reports from specialists and hospitals, all needing to be read and actioned.  This is important because a great deal of our funding is based on consult frequency, and of course that’s mainly what patients pay for. But somehow, we need to find a way to acknowledge and remunerate the vast amount of work done “off the ball”.  

Otherwise our good young doctors are going to drown in paperwork and patients are going to lose the connection they value the most.