Giving patients online access to their GP record helps redefine the relationship in unexpected new ways, says Dr Jagdeesh Singh Dhaliwal
The familiar rhyme and rhythm of the GP consultation takes place around 900,000 times each day in surgeries up and down the UK. As general practitioners we must establish and maintain rapport with our patient; take a history; conduct a physical examination; order tests if required; offer and discuss options and agree on a plan, all within an allocated appointment time of 10 to 15 minutes.
The digital age has transformed the way in which we engage with banks, shops, takeaways and just about every other service industry. Surely there must be novel ways of reimagining the doctor-patient relationship in general practice?
It was this thought that led our suburban GP practice team to embrace digital communication technologies back in 2014.
We now encourage patients to conduct ‘safe’ searches online for symptoms and conditions through our practice portal where they can access targeted self-help information and advice from a wide range of health professionals who might be able to help. We support our patients to consider using health apps and - crucially - to obtain online access to their full medical records.
We have found that where the patient attends having read GP notes from previous conversations and, having viewed test results and hospital letters, an eminently more satisfying interaction takes place for both parties
At first we were apprehensive and a bit anxious about offering digital records access. We were concerned it might confuse rather than reassure; that we would be inundated with set-up requests and that demand for GP appointments might soar by unwittingly opening a ‘Pandora’s box’ of patient uncertainty around test results or hospital findings.
The reality has been quite different.
We have found that where the patient attends having read GP notes from previous conversations and, having viewed test results and hospital letters, an eminently more satisfying interaction takes place for both parties. It feels much more like a partnership.
Rather than expending valuable appointment time paternally ‘transmitting’ information from the doctor to patient, the patient can mull over this information in the comfort of their home and process thoughts and feelings.
Older patients with multiple illnesses have glowed with enthusiasm about how much more empowered they feel through really ‘knowing what’s going on’
Time is released for us to jointly discuss what the shared data in the record means and what options might be followed. We spend less time going over old ground and focus more on co-designing a way forward. Safety is improved since patients check and advise on any inconsistencies, which are typically around changed drug doses.
Older patients with multiple illnesses have glowed with enthusiasm about how much more empowered they feel through really ‘knowing what’s going on’. Several have described how they have asked their ‘wired’ teenage grandchildren to help them to gain online access, opening up new conversation and even some fresh ‘respect’ for grandparents gaining new IT skills.
Time wasted for patients telephoning and attending to chase results or hospital letters is replaced with the reassurance that “we upload all of this information as soon as we receive it, so you can view it at your convenience.”
Today’s digital technologies open up the possibility of helping patients and their doctors to re-energise their therapeutic relationship of trust: “Here’s the data which we’ve previously both read. What sense do we jointly make of this? How do we together now find the best way forward for you?” This is the essence of what I always hoped being a GP would be about.
Dr Jagdeesh Singh Dhaliwal is a GP partner at Sycamore House Surgery, deputy director of postgraduate medicine at Keele Medical School and a consultant medical adviser in health technology strategy.