11 Jun Is it time to make room for Dr Google?
There is a wonderful scene from the classic, hospital-based sitcom Scrubs where the main character JD (a doctor) is daydreaming whilst examining a patient – he proceeds to listen to the patient’s chest with his stethoscope- the only problem is that the earpieces are not in his ears but on his neck…
The patient then asks: “I’m sorry, doctor, shouldn’t you have those things in your ears?”
JD replies angrily: “I’m sorry, did you go to medical school ?!”
Patient: “Well…You know… I thought…”
JD: “I didn’t think so!” – (sneakily and sheepishly puts earpieces back in his ears)
I often think as GPs we can be like JD in this scene when it comes to new medical technology– not willing to listen to our patients and become ridiculously stubborn when facing the harsh truth – that our patient might know something that we don’t or more specifically, know something that may help us as doctors manage their health more effectively.
Approximately 17 years ago Tom Ferguson coined the term “e-patients” to mean patients (or their friends or relatives) who seek health-related information online. He said that granting patients’ wishes for more online communication with their doctors could reduce consultation times. 
Sara Riggare brilliantly observes in her recent BMJ essay that “e-patients are the future of healthcare”. She defines e-patients as those who “use innovative strategies to improve their or another person’s wellbeing…They are involuntary innovators who willingly share both their problems and the solutions they discover” 
In preparation for this blog, I reflected on the google-effect of our patients’ lives and decided to analyse my very own google-habits. I even made a list of my most recent google searches:
- Directions to a home visit
- Cinema movie-times.
- Comparing prices of oven roasting-trays
- Price of a family weekend Trip to Legoland
Total time spent – Maximum 5 minutes
Google came out in 1998 – what would I have done with the above list in 1996, for example?
- “A-Z” map at the back of my car
- Check the local newspaper for movie-times
- Shopping trip next weekend
- Call up Legoland and wait on hold…
Total time spent approximately 3 hours
Last September The Times technology correspondent, Mark Bridge wrote an article reflecting on 20 years of Google – he states that thanks to googling “People no longer memorise information in the same way. This rewires our neural pathways and also affects our social interaction” 
Why should we as GPs get annoyed with patients when they Google their new symptoms? We live in a society that wants to absorb and understand everything around us more than any other previous generation.
Our use of technology has increased exponentially from having to ask your dad to get off the phone so you can MSN-messenger your secondary school-crush without interference, to family members streaming 4 different tv programmes, within the same house at the same time – all this in the space of 20 years!
Why are we expecting our patients to behave the same way they did in 1998 when we have all clearly moved on from that time?! Why can’t we as GPs adapt and use these advances to the improvement of our patient’s health?
As GPs we should embrace technological change and work with our patients to ascertain what they find useful. Sara Riggare also explains that e-patients have a shared responsibility with their doctors to be just as engaged as them when it comes to their health. She goes on to explain the that the results of mutual partnership with their healthcare providers is much more beneficial compared to the alternative of not collaborating with healthcare providers. 
Medical technology has naturally migrated from our computers to our watches, phones and Fitbits. Wearable technology is revolutionising the way our sportsmen and sportswomen perform. For example, most of the top football teams in the world use wearables, relying on GPS devices on the back of players’ vests to measure heart rates. You only have to look at the latest Apple Watch launch last September to observe how much the consumers value health-monitoring. Analysts at Gartner, expect to see 310.4 million sales of wearable devices worldwide this year, generating $30.5 billion and the International Data Corporation (IDC) expects the market to double by 2021. & 
A recent BJGP qualitative study highlighted how the use of technology by female patients diagnosed with gestational diabetes may help reduce the risk of progression to T2DM. The study identified a clear need to research the efficacy of technology in addition to traditional face to face care. The noted benefits included personalised self-management of patients’ health via goal-setting, reminders, self-monitoring, feedback, and rewards. 
I think this diabetes study highlights the following – that technology should NOT replace the face to face consultation between a clinician and their patient. Rather these technological advances should work synergistically alongside traditional methods of healthcare to improve the holistic and clinical experience. Some online apps declare that patients will never wait to see their own GP again. As Martin Marshall et al wisely warn us, we should strive as a profession to ensure that ‘people using online services are fully informed” and that they “develop online services as an integrated part of established general practice and not in competition with it.” 
Some patients see doctors as stuck in the past and unwilling to change. I can both understand and sympathise why some patients choose to switch to providers like Babylon health, for example. Jonathan Griffiths brilliantly observes in his latest blog; “as a profession, we need to acknowledge that our satisfaction rates are lower than they have been for many years, and that levels of expectation are rising. If we don’t do something to address this, then our patients will vote with their feet. They will choose the convenience of the app-based provider.” 
I recently listened to a wonderful podcast “2 GPs in a Pod” hosted by Dr Shubs Upadhyay. I was fascinated by his interview of Dr Keith Grimes and his work on using virtual reality (VR) to help his patients. One of his latest projects is ‘clinical holoportation’ -“the use of virtual, augmented and mixed reality to allow for users to virtually occupy the same space and interact in 3 dimensions while miles apart”.  It may sound like science-fiction but I wholeheartedly agree with Grimes on the amazing potential of using this technology in primary care – it only seems inevitable and logical that general practice will one day, reap the same benefits of other industries where VR is currently widely used e.g automative, entertainment, education, professional sports – to name a few!
We need to embrace new technologies in order to keep up with our patients’ desire and hunger for a modern and fulfilling patient-experience. It helps me to think of the Pendleton consultation model when trying to in incorporate these new ideas:
1. Understand the problem
2. Understand the patient
3. Share understanding
4. Share decisions & responsibility
5. Maintain the relationship
This adaptive mindset establishes a patient centred approach and by acknowledging this, we can use technology to deliver the best type of care to our patients. Change is never easy but as we try to innovate as a profession whilst simultaneously moving with the times, it seems apt to quote the “father of science fiction” who once lived in the same town, that I live in now:
“Adapt or perish, now as ever, is nature’s inexorable imperative”- HG Wells
- The first generation of e-patients, BMJ 2004 ;328:1148-9.
- E-patients hold key to the future of healthcare, BMJ 2018;360:k846
- “20 years on, How google has changed everything “ Mark Bridge https://www.thetimes.co.uk/article/20-years-on-how-google-has-changed-everything-larry-page-and-sergey-brin-xtpgmqpgb
- “Million megabit kits: how wearable tech is shaping the future of football” Sooraj Shah http://www.wired.co.uk/article/real-madrid-wearable-tech-shaping-football-future
- IDC Forecasts Shipments of Wearable Devices to Nearly Double by 2021 as Smart Watches and New Product Categories Gain Traction” https://www.idc.com/getdoc.jsp?containerId=prUS43408517
- Reducing risk of type 2 diabetes after gestational diabetes: a qualitative study to explore the potential of technology in primary care. Br J Gen Pract 2018; 68 (669): e260-e267
- Online consulting in general practice ; making the move from disruptive innovation to mainstream service. BMJ 2018;360:k1195
- “Telling it as it is .. time for change is now .. for all of us” by Jonathan Griffiths https://gpview.co.uk/time-for-change/
- Day 17: Clinical Holoportation by Keith Grimes http://www.drgrimes.co.uk/day-16-clinical-holoportation/