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Lights, camera but no community action

I like computers. I spend much of my working day staring at a screen, while patients of all sizes and ages gaze thoughtfully at the side of my head. I received an email the other morning which set me thinking. Would I, it asked, like to earn money by being the doctor in video consultations?

Well, would I? The patients (or would you call them ‘consumers’?) would stare at my face instead of my side profile. I could be at home, wearing Wellingtons, peering down the throat of a man in Monaghan. It sounded like a good plan for the retirement. I would have no premises, no staff — just me, a laptop and a patient in a hurry.

But there was something about the idea that did not sit well with me. As the day went on, I began to get a renewed appreciation of what I, and every GP, does all day. As the patients, or clients or customers, came in and out, I noticed the things we do to create a rapport, the discussions about family, the body language, the handshakes, the jokes, and the follow-up, and I began to get an idea about what we are asked to sell out.

Computers can be wonderful, but their ghostly electronic glow seduces you away from real life to a land of mirrors and smoke. They are not real, and ultimately give no sense of fulfilment. If you spend a day at the screen, you do not feel like any real work has been done and you need to chop wood or go for a run to regain a sense of accomplishment.

The daily work of a traditional family doctor is like a trip to a farmer’s market. When you go to the market, you take your time. You are aware of sounds, sights and smells. The produce is local and sustainable. You are cutting out the middleman. The money is raised and spent locally. The two important concepts are quality and community.

A video consultation has no element of choice. You take who you get. There is no shared history. The doctor is reduced to a box-ticker and the patient to an algorithm. Instead of the trip to the farmer’s market, you face a soulless trudge under the neon lights of hypermarket; talking to nobody as you fill a trolley with chemical rubbish in gaudy packaging. There is no quality.

Is the future for Irish general practice a soulless medical store on the outskirts of a big town designed solely to make money?

There is no value, either. Supermarket value is a false concept; they sell you a scrawny baby chicken raised in cruelty which barely makes one meal, instead of a decent-raised bird which will feed a family healthily.

Those with too much time on their hands buy sliced cheese and washed spuds, all the goodness bleached out of them. Farmers are ripped off and the money goes overseas. Is the future for Irish general practice a soulless medical store on the outskirts of a big town designed solely to make money?

There is an argument for video doctors in areas where there is no doctor, but it is a poor one. We should try to build communities, not glorified phone-boxes. A village should have a doctor, and a butcher, and a pub, and a teacher. If you don’t want to live in a city, you should not be forced to live in one and if you do want to live in a city, we should build communities in these too.

An online doctor won’t send her children to the local school, or bring their car to the local garage. They won’t go to your parent’s funeral, or do a house call, or watch over your kids from the sidelines of a match. They won’t stop a man in the street who they know has not collected his antidepressants for a chat about hurling and then arrange to see them that afternoon.

I always felt that the Luddites were misunderstood. They were skilled craftsmen who tried to protect their jobs and way of life. The machinery owners shot them and the survivors were coerced into the hellish industrial cities of Victorian England.

We doctors are in real danger of losing our way of life here and losing a special relationship with our patients and communities. I can appreciate a need for video consultations in far-flung outposts and developing countries. I suppose these countries will benefit when the companies that are setting up the video consultation model decide to enlist doctors in Delhi at a fraction of the cost of Irish ones, like the call centres do now. Well, good luck to them if they do; the Asian doctors kept our hospitals going for long enough. It will be a pity, though, to see another rent in the fabric of our communities.

I like computers, but technical progress is not always in the interests of humanity. I won’t join the video-linked race to the bottom.

  1. David Taylor on February 8, 2017 at 11:42 pm

    Great argument Dr. Harrold. I for one vote for the community engagement and the closeness and atmosphere of the village. Interacting with the remote-Doc over the tube, is not the experience I seek with someone who should know me as well, if not better, than I know myself, in terms of wellness and medical.

    However, is there an opportunity in the virtual experience to preserve the village GP. In the village there may not be the demand locally to serve the GP practice, and that demand could be fulfilled by the fast and furious city-dwellers via internet consultation. There are many professions today, that leverage the interconnectedness provided by the internet, to live where they want to live.

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