It is over 50 years since Michael Balint wrote about the consultation model, and there have been many other worthwhile contributors to education around this area since then. It is an area of our day to day work that can always improve, and will develop and change over time as we acquire new skills and learn more about our patients. The vast majority of our consultations take place face to face, but over recent years we have made increasing use of the telephone to triage and consult with patients. Some doctors like this more than others-and patients feel the same. But what of Skype? How does this fit in to current consultation models?
I like technology- smartphones, gadgets, touch screens and all that, but I really don’t like Skype. Socially, I view the phone as a means to an end-a communication tool, bullet points needed, a minimum of conversation. Texting is great for me-I can do it when it’s convenient, short quick messages, get the points across and move on. I have never been a great conversationalist (just ask my wife…) so prolonged phone calls are not really for me. 100 free minutes on my mobile phone contract-that will last me the year not the month. I can see why others feel differently and use the phone to keep in touch with family and friends- and Skype for many will be an extension of this. For me-I find it awkward and stilted with the worst bit being the goodbye. Is it OK to hit the end button now? Are they still looking at me? Shall I let them do it first? I have used it a few times to talk to the kids when I’ve been away without them (rare in my line of work)-and I can cope with the social indecision with them. But patients? What will it add?
I spend a lot of time consulting face to face but also over the telephone-especially in the out of hours setting and I feel comfortable with the processes involved. Much of what we learn from patients is from the narrative itself, with any examination needed a supplement to that. I am left wondering what Skype can add to this from a doctor’s perspective and can really come up with only a few examples. Will it aid us in making a diagnosis or should we look upon it as a system that might help patients (and politicians) more than doctors? Is it possible that patients will be reassured by simply “seeing” their doctor-I doubt it.
As with all things new, no parameters of normal have yet been developed-so knowing whether we are doing it “correctly” is going to be difficult to judge. When mistakes or complaints are made-who will judge what a “normal GP” would be expected to do? It is possible to record Skype calls but it does not look terribly straightforward so this may be an option for some and could be useful to both patients and doctors.
I am struggling to think of a long list of conditions that I might be able to deal with over Skype that I would not otherwise deal with over the phone. Confirmation of minor skin conditions maybe-urticaria, viral rash or even shingles spring to mind. Cellulitis ? A vague swelling somewhere? External thrombosed piles? It may be that the only way forward is to suck it and see (not the piles), embrace the technology if it works, tread carefully, safety net and, if in doubt, arrange a face to face consultation.
The next step, of course, will be a daily skype update from the care home staff….