14 Apr 2014

Doctors on Skype: ‘People show me all sorts of things’

The doctor will Skype you now: One GP explains (via Skype) how a Skype consultation works, and says some people prefer it to meeting face to face – especially for those more embarrassing ailments…

Skyping your doctor may seem like a last resort: something you would only do because you cannot get an appointment.

But Dr Will Murdoch says that some people seem to actually prefer it. “My most memorable example was a young man who had scabies on his penis. He was more than willing to show that to me,” he told Channel 4 News.

Dr Murdoch works at Birmingham’s Vitality Partnership and consults on Channel 4’s Embarrassing Bodies. “For some people I think having that slight distance knowing that there’s someone at the end of the camera, but not having another person in the room with you, does encourage people perhaps to show things that perhaps they otherwise wouldn’t,” he added.

The government wants more GP surgeries to open in the evenings and weekends, and to provide “remote access” consultations for patients, either via email or through video calling on Skype.

Billed as a “fundamental shift” in frontline NHS care, the £50m GP Access Fund aims to give more people access to GPs when they need it. A&E departments have been inundated by patients who do not need emergency care, and the trend has been blamed on these patients being unable to get appointments at their GP surgeries.

The new scheme hopes to flesh out the services provided by doctors, and the government says 1,100 practices will eventually be involved, serving more than 7.5m people. Initially, 20 practices will run pilots for a year – and one of them is Dr Murdoch’s practice in Birmingham.

When it works

He already communicates via email with some patients, and is looking forward to starting video consultations, having worked in this way while working on Embarrassing Bodies for the past two years.

I think having that slight distance… does encourage people to show things that perhaps they otherwise wouldn’t. Dr Will Murdoch

Presuming the patient is computer literate, setting up a Skype call is not much more hassle than calling the doctor over the phone. But it provides much more information on the patient, Dr Murdoch told Channel 4 News.

“You can make simple measurements like how fast is somebody breathing? Do they appear anxious? Are they pale? These are additional things that are over and above what you can get from a simple telephone consultation.”

Doctors can diagnose things like conjunctivitis and skin ailments over a video connection, but mood and mental health can also be assessed to a large extent by a patient’s behaviour and how they look.

And as mentioned above, some patients are actually more comfortable speaking to a doctor via webcam, as opposed to in person.

It is likely that some medical problems will require a follow-up consultation in person. But Dr Murdoch’s view is that a video call can be a very successful, and efficient, first port of call.

When it does not work

Shortness of breath, heart pain and any life-threatening situations should always be dealt with by emergency services.

Assesessment of pain to do with bones, or suspected fractures, along with a range of stomach problems, will need to be examined in person: if patients are sure this is the problem, then they will need to book an appointment.

Obviously blood pressure, weight and blood tests would have to arranged separately – until the day when we all have smartphones that do the job for us – and the GP surgeries involved may end up introducing a two-tier system of appointments, where face-to-face appointments are booked when the doctor wants to have a closer look.

My most memorable example was a young man who had scabies on his penis. He was more than willing to show that to me. Dr Will Murdoch

There may also be a concern about the kind of patients being reached: Skype may be a great option for busy, tech-savvy professionals who cannot get time off work to visit the surgery.

But what about older generations who are not so used to communicating though their computer, let alone receiving personal diagnosis?

Dr Murdoch admitted that he suspects his younger patients will be most comfortable about the idea of skyping their doctor. But he added: “That doesn’t exclude the older population. We’re starting to see increased uptake of older users.”

Funding concerns

In a world where you can monitor your heart via an app on your phone, skyping the doctor does not seem like a huge technological leap: but it is a big psychological step, for patients as much as NHS bureaucrats. And there are still concerns that the proposed reforms will overstretch already heavy burdens.

Just last month, the head of the Royal College of General Practioners said that GPs were under threat of “extinction”, because of increasing workloads and squeezed budgets. Dr Maureen Baker said that GPs were already unable to give patients the time they need, and that they were burdened by “a toxic mix of increasing workloads and ever dwindling budgets”.

And on Monday, the British Medical Association warned that changes to the GP contract needed to be backed by investment.

Dr Chaand Nagpaul questioned whether already stretched practices would be able to extend opening hours and expand their services, and pointed out that all the 7,000 GP surgeries that are not signed up the Access Fund pilot were receiving no extra support.