There is no doubt that medicine is a complex business. 6 years at medical school gives you the BASIC knowledge to work as a doctor. The next 10 years are focussed on adding to this knowledge and refining your skills. When you reach the “top”, the learning never ends, it just continues as science changes the way we treat people.
Your GP or Family Physician has to learn different skills compared to your hospital doctor. When you work in a hospital you have access to blood tests, xrays and scans, the tools to help make a diagnosis. These can be done straight away but most importantly, the results will be back on the same day. In Australia and the UK, your GP can do the same tests but the results will not be back for a few days. So your GP has to decide whether a patient is well enough to wait for a few days for the tests to come back. If they are, the test can be done in the community. If they are not, they must go to the hospital now.
Ultimately, your GP is a medical risk manager. What is of interest and may be a bit scary to know is that the physical tools the GP has to make a diagnosis are really quite basic, (we will go into what these are later). Much of the diagnosis is based on the GP’s ability to gather information from the patient by talking to them. They then confirm the diagnosis using the basic tools and decide on a plan based on how urgent they think the problem is. Let me explain in a bit more detail.
When someone comes in with a problem such as a cough, I create a list in my head of about 10 things that could cause it. This list starts off with the worst case scenario, eg cancer. It then has the common causes of coughs and then the uncommon causes. Over the years I have learnt about all of the conditions on the list: what symptoms they cause, what you would find if you were to examine someone with the condition, what tests are needed to confirm the condition and how to treat the condition. With years of training I have honed the questions that I ask the patient. With each question a condition gets crossed off or may get added to the list until I have a handful of conditions that I have a strong feeling could be a cause of the symptoms. Once I reach this point I crack open my tool box to examine the patient. I am looking for particular signs that would confirm or disprove the condition that I am considering.
This is where it becomes alarming to people out there. As things stand, the tool box I have is really basic. A blood pressure machine, thermometer, a wooden spatula to look in a mouth, a torch to look in an ear and eye, an oxygen monitor, a stethoscope and something to test your urine. That’s pretty much it. Some doctors have a bit more, but not many have less. What it means is that much of your diagnosis is based on your GPs skill and training to get information simply by talking to you. It is the interpretation of what you say and what your doctor finds with very basic tools that determines what your diagnosis is.
Ok, that’s all very interesting doc, but what relevance is that to me as a patient? Well if you have those basic tools at home, then you can get your GP to interpret it remotely. The information gathering is mostly done by talking to someone which a GP can do online. If you can provide the information that the doctor would ordinarily get using the basic toolkit in the clinic, then, within reason, you can have a fairly effective consultation.
Don’t get me wrong, there are times that you have to see someone in the flesh but much of the time you do not. Many online GP services will have the safety net of organising an in person review if there are ANY concerns. But for health problems that could be dealt with online, if you could provide the same information that would normally be checked in a clinic, you can obtain the nirvana of being able to access a medical review anywhere, at anytime and at YOUR convenience. No need to take time off work or find someone else to look after the kids just to be told, “don’t worry about it. Your cough will settle.”
The number of times that I have had patients complain about having to take time off work to see the GP and all they get is reassurance and no antibiotics. I totally understand the frustration and this is why I feel that having the right tools at home and access to an online GP can make the assessment of someone with a health problem more efficient.
So what information do I need to provide?
If in addition you have a digital stethoscope then your chest and abdomen can be examined. Add a torch and your throat can be examined.
Companies are creating solutions that provide all of these tools in one piece of kit. A company called Tyto Care from Israel is doing this. They are launching in the USA but the UK and Australia must wait.
Healthy.io produce a home urine kit that can check for urine infections and kidney problems, (not available in Australia, yet). None of these products are too expensive and for the cost of a big night on the beers, you can obtain a mobile GP clinic. Finally you can start avoiding the frustration that occurs when you have to break your routine to see your notoriously inflexible GP.
The GP can do what they do best, which is talk and listen to you. They can guide you through using the necessary tools to obtain the information that they need and make a decision on what the next step will be. Sometimes you will have to come in for an in-person review. Sometimes you won’t. It will be up to the doctor to ensure he or she can make a safe decision with the information to hand.
The bottom line is that if you know what information your doctor needs and can give it to them accurately, your life will become so much easier and healthcare will become like most other industries have become, easy to access at a time that is convenient to you.
Blog post written by Dr Khurram Akhter.
Khurram is an experienced primary care physician and a thought leader
in the field of digital health.
Disclaimer: This text does not serve as medical advice and if you have any questions, seek advice from your doctor.