However you look at it, Jeremy Hunt is not popular with doctors at the moment, which is perhaps an understatement of somewhat heroic proportions. Leaving aside the small matter of imposing a contract on to junior doctors in the last week, triggering the prospect of a major meltdown in hospital doctor and GP trainee staffing levels, he also came up with the bright idea recently of using Dr Google instead of a health professional to diagnose illnesses. If you remember — whilst admitting that more doctors and nurses were needed — he then said in the same breath that looking at online photographs of various rashes may help you decide if your child’s rash was serious or not. This quite correctly invited bucket-loads of opprobrium to be rained onto him from a great height by health professionals, many of whom posted identical-looking photographs of rashes — some fatal, some not — and invited people to spot the difference. The Department of Health was quick to backslide, stressing that parents should access the ‘appropriate services’ and not hesitate to contact a GP if concerned.
But was he wrong? After all, the days of patients coming into my consulting room with a list of problems scrawled in pencil on the back of a fag packet are long gone. These days, I expect at least half a dozen pages of A4 printed with information trawled from the internet to be put in front of me, usually followed by me taking up the whole of the consultation explaining why that patient hasn’t got the illness a Google search has suggested they have. And there’s the rub, and why he is wrong. Yet again. Patients have never been better informed. The trouble is, they have not been better educated at the same time. The internet has no filter and so if you type in ‘headache’ to a search engine, a hundred possible diagnoses flash up — including brain tumours — and so it’s only a small step from a few clicks of a mouse to then turning up in my surgery with a headache stating ‘I have a brain tumour’ as a hard fact.
Well, this is why you have GPs. We are the gatekeepers of the NHS, not only trying to stop the whole system collapsing, but also taking the hard decisions with virtually every patient we see as to whether they are ill or not, require tests or treatment or not, or if Dr Google has actually called it right this time (this one is pretty rare). Whether it is down to intelligent diagnostic ability, years of experience as a GP, a gradual process of tests, or simply a sixth sense hunch that so many doctors seem to possess after a while, this is where we earn our corn. Making the call, taking the responsibility and sometimes sweating on whether we’ve read the situation correctly. Asking the internet to do that for you just doesn’t work, and never will.
Many A&E departments now have a rule that junior doctors cannot see and discharge paediatric patients without discussing the case first with a senior doctor and this is quite right too. Why, then, does the Secretary of State for Health appear to believe that it is quite appropriate for a parent, with no clinical training whatsoever, to trawl through pictures on the internet and then make a clinical diagnosis? Does clicking a mouse allow a parent to carry out an examination, recognise complex medical signs, undertake laboratory tests or distinguish between infectious and non-infectious disease? Not last time I looked it didn’t.
Putting it bluntly, what my worried parents always need is medical advice from an experienced doctor they trust, not a search engine. The problem here, as we enter the Brave New World of wherever the NHS is now heading, is that as services are spread more thinly with less and less staff covering more and more complex cases in an ageing and growing population, online health pages and forums are often more readily available to give comforting — or more usually, worrying — advice at any time of day or night to an already worried patient. There is an irony here in that the average GP practice receives £136 per patient annually to provide everything for that patient. With the cheapest Sky TV subscription, many annual broadband costs, a haircut every month, or the cheapest 4G free phone subscription each costing more than that, we may well end up getting the level of health care we deserve, and which no one actually wants. Except Dr Google.