The well-intended promotion of digital solutions to improve patient access threatens the essence of what it means to ‘be the GP’.1,2 In the name of efficiency, patients are increasingly obliged first to ‘talk’ to a computer. This model overlooks the art of the ‘therapeutic history’, a sacred moment where patients put trust in the GP to hear and to interpret their story.3 The value of ‘doctor as drug’ has long been recognised and it is in this encounter that the healing process begins. Thus, it remains common for patients — in response to a professional, sensitive, unhurried ear — to state: ‘I feel better already, Doctor …’
A further benefit of the therapeutic history is that it promotes ‘well-judged’ clinical restraint, that is, self-care, incremental management, and the option not to intervene at all.3 The digital algorithm, by contrast, fuels expectations, anxiety, and workload by concluding ‘needs bloods/ecg/cxr then see GP’. Many of these tests will prove unnecessary, not least because about a half of presentations in general practice lack an overarching diagnosis to guide management.
The holy grail of the ‘digital front door’ must not be to divert or delay as many contacts with the GP as possible. The experienced receptionist remains central to ensuring that patients receive appropriate initial management, particularly vulnerable patient groups. Digital triage risks undermining the receptionist’s art of helping to tease apart unprepared presentations and recognising that certain patients simply need ‘to speak to the GP, before going any further’.
Trainees choose general practice because they enjoy talking to patients. Digital triage risks putting the technological cart before the discursive horse. It also endangers the art of the ‘therapeutic history’. Anxiety famously makes children of us all4 and its best remedy in early illness is to ‘speak to a GP’. Digital triage is not a ‘one size fits all’ solution for a battered GP profession and a public who have increasingly lost the ability to judge degrees of urgency. Preserving the art of the consultation as the bedrock of general practice is critical for patients, sustainable use of resources, and to ensuring recruitment of tomorrow’s GPs.
- © British Journal of General Practice 2024
