January 29. I cannot remember the last time I had a face-to-face conversation with my doctor. Probably in 2019, perhaps earlier. To know how he and his profession are managing in the pandemic I turn to the new account by an Edinburgh GP, Gavin Francis.*
Francis and his publisher, together with the Wellcome Collection, deserve praise for getting the book out while the crisis is still in full flood. Inevitably there is a cost in coverage. The narrative ends in the autumn of 2020, before the third surge in infections and deaths.
Throughout Intensive Care, Francis is concerned with the consequence of talking with patients only by phone or through masked faces:
“As GPs we’re taught to value the subtleties of human communication – to glean as much from what the patient doesn’t say as from what they do say. As trainees we have to submit videos of our consultations to demonstrate how carefully we attend to body language, to silences, to the way patients hold or evade eye contact.” (p. 56)
My surgery is located in a nearby large village. In common presumably with all practices, its switchboard has been greeting callers with a recorded message explaining that only telephone appointments can be made; the doctor will then decide whether it is necessary to see a patient in the surgery or at home. If you stay online, you then get a recorded message purchased from some third-rate utility: “Your call is very important to us. Please wait for the next available agent.” This week, however, there is an additional message which I encounter when I ring to renew a prescription:
“Our phone lines are very busy due to the volume of calls we are receiving about the covid19 vaccine. The NHS is prioritising vaccinating those people who experts have agreed would benefit from it the most. We will let you know when it is your turn to book you a vaccination. If would like more information about the vaccine, please visit http://www.nhs.uk/covid/vaccination. If your query was about the covid vaccine, please hang up now.”
So not even a someone to talk to on the other end of the phone. Rather implied censure for making the call in the first place. Clearly this is a surgery under stress. But it is possible to suggest another response which acknowledges that:
• receiving the vaccine is for vulnerable groups by a distance the single most important event, medical or otherwise, that they are facing;
• at this moment, potential recipients are being treated differently in different regions and you well may know of people in similar circumstances who have already been vaccinated;
• in so large a project there must always be an apprehension that as an individual you may fall through some bureaucratic crack;
• over your lifetime you have been used to treating your GP surgery as your portal for all health enquiries, and that being re-directed to an impersonal website offers little comfort.
In the concluding discussion to his book, Gavin Francis is preoccupied with the defects of non-face-to-face medicine, necessary though it may be in the crisis:
“As time goes on, and if telemedicine prevails, those relationships forged in person will become more remote, and the medicine GPs practise will become more perfunctory, based on the avoidance of being sued rather than on what’s best for the patient. Those conversations would be not ‘consultations,’ but triage, fire-fighting, damage limitation. It’s difficult enough to engage with the unique complexity of another human being’s suffering in ten or twelve minutes when sharing the same space, but on the telephone it’s near impossible.” (p. 191)
With doctors, as with so much else, the meaning of this pandemic will not just depend on the temporary expedients that are adopted. Rather the question is which emergency devices are rescinded the moment the crisis is over, and which are allowed to persist, whether out of inertia or institutional self-interest.
* Gavin Francis, Intensive Care. A GP, A Community & Covid-19 (London: Profile Books and Wellcome Collection 2021).