By Professor Maureen Baker, Chair of the Royal College of GPs
Would you rather find out you had terminal cancer from a smartphone app, or from a sympathetic and well-trained human being?
I’m no clairvoyant, but the idea of technology replacing doctors – a topic raised by two articles in the Telegraph over the last couple of weeks – is not one I can see happening , or anything close, for a very long time if ever.
One editorial went so far as to claim that GPs should be working harder in order to meet the growing demand of our ageing population. I’m not quite sure how.
GPs and our teams are working harder than ever to deliver well in excess of 370 million patient consultations this year – upwards of 60 million more than five years ago. Yet the funding for our service in real terms has declined dramatically over the last ten years, and our workforce has remained relatively stagnant. It certainly hasn’t risen in accordance with demand. We can’t “work harder” without significant investment in our service, including thousands more GPs. Trying to do so would threaten our patients’ safety and put our own health at risk.
We need more resources and we also need less red tape keeping us away from frontline patient care. We also need the media to stop telling us to work harder when we’re already working ourselves to the bone. As GPs, we are not resisting the use of technology. In fact we want to maximise our use of technology as part of a 21st century health service.
The potential for us, for the NHS, and for our patients is phenomenal. In many respects, general practice is leading the way in implementing technology in healthcare. We were the first service to introduce electronic medical records and now 97 per cent GP practices now also offer some form of online access to patients, be it the ability to book GP appointments, ordering repeat prescriptions, or accessing their medical records (something the College is supporting family doctors and their teams to implement).
These services can be particularly beneficial for our growing number of patients with multiple complex and chronic conditions, for which our health service is not designed to deal with in such huge and rapidly growing numbers. Technology can also support patients to care for themselves, and help to foster active lifestyles – essential in order to keep general practice, and the wider NHS, sustainable whilst resources are so scare and demand for GP services is so high.
Gadgets like Fitbits and Jawbones and other monitoring devices, and consoles like Nintendo Wiis, are already facilitating this, And the fact they are becoming so popular amongst a wide demographic can only be a good thing. But gizmos and gadgets can’t do everything. The role of a doctor is multi-faceted. It isn’t just clinical knowledge or use of data; it’s judgement, it’s communication, it’s diplomacy, it’s tact, it’s pattern recognition. Crucially, it is the ability to apply that knowledge and adapt it to suit the patient in front of you, within the prevailing ethical and regulatory frameworks.
A computer or robot or algorithm might be able to do elements of this but not all. These days, people very rarely have just one thing wrong with them at any one time. Machines, no matter how good they are, are a long way off from being able to handle that complexity at the moment, and nor are they likely to. Fundamentally,no machine or programme has any “understanding” of the human condition.
In the short term, there are also patient safety concerns. We are all aware of the potential for human error but errors in technology can happen too. And, as yet, there are few safeguards for software in comparison to those in place for the drugs, devices and, yes, the humans in the system. Take apps, a growing market with massive potential. Kitemarking isn’t readily available and the current medical regulatory framework for apps that are registered as medical devices is not fit for purpose for 21st century apps and the way in which technology is evolving.
It is essential for patient care that apps provide correct, evidence-based information and that appropriate safeguards are put in place – there is definitely a need for some form of regulation
We also have concerns about the patient safety implications of apps offering virtual consultations via smartphones. Patients will be having consultations with GPs who are unfamiliar with – and won’t necessarily have access to – their medical history, or information about drugs that they have been prescribed. Medical histories provided by patients themselves will rarely be as comprehensive as those held by their family doctor. There are also many signs and symptoms that GPs look out for when making a diagnosis, that the patient might not think to raise. And a virtual GP cannot conduct a physical examination.
So, in my opinion, technology will never replace doctors. But healthcare professionals should embrace it for the benefit of our patients and the future sustainability of our health service.