‘Bad old habits’ … and what really matters

Deborah Swinglehurst; Chris Dowrick; Iona Heath; Stefan Hjörleifsson; Sally Hull; David Misselbrook; Joanne Reeve

doi:10.3399/bjgp20X712745

Matt Hancock has urged GPs (30 July) that ‘all consultations should be teleconsultations’ and that we mustn’t ‘fall back into bad old habits’, thus freeing up clinicians to concentrate on what ‘really matters’.¹

Teleconsultations are potentially dangerous for patients and professionals. It is vitally important not only to be able to listen to the patient, but also to see them and to touch them. Without the ability to examine patients and pick up other clues, diagnoses will be missed or delayed.

Teleconsultations may also prevent those who are disadvantaged or in danger at home from seeking appropriate help. Although they may offer convenience for some patients with discrete, clearly defined problems, teleconsultations are incapable of embracing the inherent ‘messiness’ of most clinical situations.

What really matters is that we maximise opportunities for meaningful therapeutic engagement with patients. It really matters that we do not assume that what has been necessary in a crisis represents what patients or clinicians want or need beyond.

The consultation really matters. It is not simply an exchange of facts, diagnoses, and prescriptions. Done well, the consultation is of therapeutic value, especially when embedded within an enduring relationship. If, as Hancock suggested, we are to ‘encourage and celebrate generalist skills’,¹ then we must retain the consultation at its centre.

We urge caution in mandating a wholesale shift towards teleconsultations without thorough evaluation. Existing research suggests that telephone triage increases workload with no cost savings, and the value of e-consultation and video-consultation remains controversial.

GPs and patients across the UK are on a steep learning curve, working out how to ‘do’ remote consultations out of necessity, and it is highly likely they will find their place within mainstream practice. However we do believe that some ‘bad old habits’ may be worth holding on to.