March 12, 2018
"I might as well have googled it myself." Just occasionally our practice manager receives a complaint that a doctor was using the internet to access information during the consultation. This is a far cry from the doctor being clueless and doing a blind search to find basics – they will be heading directly for valuable on-line resources and information that will enhance the quality of the consult and add value for the patient.
This century there has been a massive change in the way we all operate our lives, and now many of us can not remember when we did not have access to social media, mobile phones or the internet. In health care there have been changes too, doctors now use web-based information in the way they used to use text books.
It was interesting to hear a medical student's reflection on general practice after her time at Medplus. She could not begin to comprehend how much GPs need to know about every branch of medicine and could not understand how we successfully managed to be up to date in everything from psychiatry to orthopaedics, from paediatrics to elderly care medicine and from travel medicine to palliative care. Whilst hospital specialists can get comfortable knowing their small niche of medicine inside out, general practitioners have to have a working knowledge of every speciality. Although the acquisition of the knowledge and experience required to operate in such a vast field seems a daunting task, it does permit GPs to work holistically, to see the patient as a whole rather than just focusing on the part that is not working well. The reality is that there is so much information that general practitioners need to be on top of, that they can not expect to keep it all in their heads and operate safely. Good GPs need to use their broad knowledge base to recognise when they need to reference technical information and guidelines, and have systems in place that means that trusted and safe information can be found quickly.
Fortunately, as our IT systems advance, it gets easier to access vital information to optimise patient care. For example, whilst writing a prescription we are only one click of the mouse away from the New Zealand Drug Formulary – meaning we no longer need to be painstakingly hunting out drug information, contraindications and side effects in a big printed book.
There is so much information readily available for GPs now, it would be very short sighted not to access it when it can provide useful information during a consultation. You will perhaps remember the huge number of text books GPs used to have by their side? These have dwindled away now we have instant access to quality health information on line. One of the best on line resources is the ever-expanding Auckland Clinical Pathways. Millions of health dollars have been spent creating on line guidelines, for primary care doctors to use, during consultations, for a multitude of diseases and conditions. These guidelines have been regionalised, so that they make sense in the local environment that we are working in and the restraints we have to operate under. These guidelines not only ensure updates and advances are disseminated to GPs, but also link into specialist referrals. Increasingly hospital doctors are rejecting patient referrals until all the steps in the guidelines have been completed. As the guidelines are continually being updated and modified it would be impossible to keep track of changes without referencing them. The district health boards see the guidelines as a tool to increase quality and consistency of care. Initially when the guidelines were introduced the more mature and experienced doctors felt that these guidelines were insulting and unnecessary, but grudgingly accepted they may be useful for newly qualified doctors. However, this notion is completely out dated, and now the brightest, the best and the most experienced doctors keep the Auckland Regional Pathways tab open on their computer for frequent, fast reference and access it multiple times each day. This has been a massive shift, and doctors have all had to come to terms with the fact they sadly do need to break eye contact with their patients and turn to their computer screen intermittently during the consultation.
Doctors also have a variety of other on-line resources, for example, many use Dermnet as a brilliant skin reference tool, and often show patients photos to demonstrate what they believe their skin condition is and look up management of weird, wonderful and rare conditions. Doctors also frequently dip into travel medicine websites – the recommendations for prevention and treatment of tropical diseases are always changing and we need to be absolutely certain we can accurately determine what risks there are for a specific destination.
The health care industry, on the whole, have been slow to embrace the IT revolution and are still not utilising new technology optimally. Twenty years ago, it was thought a practice was advanced just to have computerised records, and many practices have not moved beyond that. However, there is currently much disruption happening in our industry, and unless we change we will be doing our patients a disservice. At Medplus we have been very proud of being innovative and cutting edge with our IT, for example we achieved national recognition for the roll out of our patient portal and are used as an exemplar to other practices. Medical practice in the future will be very different to today, with the advent of artificial intelligence interpreting massive medical data sets and allowing doctors to really personalise treatment plans.
So, yes, your doctor may pull up reference material on the computer, but no, this does not indicate they have a lack of knowledge or ability. Nor does it mean they are not listening or paying you attention. In this rapidly changing world the only way forward is for the health care industry to embrace IT systems to help doctors practice medicine safely and offer the best outcomes for patients.