A doctor’s Bag for Tomorrow: Packed with Apps, AI and Good Old Fashioned Eye Contact

A previous article in the BJGP asked the rhetorical question of whether British GPs seeking greater wellbeing should move to Denmark. ¹ Perhaps they should read this book first. It claims that ‘The Danish Healthcare System is efficient and highly digitalized and ready to meet all possibilities in future medical treatments. Two Danish Family Doctors tell us how.’

Andreas Pihl and Michael Skov Hejmadi have used a fictional GP, Louise Hansen, to illustrate what a digitally enabled primary care could, and in many cases should, look like. While they are tech enthusiasts, the authors are at pains to emphasise that technology should be implemented well. The consequences of thoughtless implementation are at worst fatal and at best a waste of precious clinician time. For the former, they give the example of a study involving a telemedicine approach to diabetic foot ulcers, noting with worry a significantly higher mortality rate in the TeleMed group.

Many readers of the BJGP will recognise their description of electronic discharge summaries. These are automatically generated and I love the authors’ description that this is ‘not in a cool way. They arrive as chaotic piles of words, with patient information — sometimes collected over many years — delivered as scattered fragments without any logical coherence. Important pieces of information are presented side-by-side with completely irrelevant ones in a careless jumble.’

In the fictional example that they describe, the discharge summary of a febrile baby states that the child doesn’t smoke, drink alcohol, or take drugs, and that the child’s sexuality is unknown! While I haven’t seen a discharge summary that is quite so silly, it does regrettably resonate with the automated discharge summaries that appear to be written for a computer rather than a human patient or clinician.

The authors argue that we have an ethical duty to embrace digital technologies in primary care and that this duty is founded on distributive justice. As a closet ethicist, I flinched a little when I read that digital technologies should be adopted ‘because of ethics’. In fairness, they argue that clinician time is too valuable to waste on things that could be done by clicking a box or by answering automated questions on a proforma.

I’m very pleased, however, to see the caveat that time that is saved has to be given back to clinicians in a sincere way. This means more time to deal with complicated and difficult cases, and not more complicated and difficult cases shoved into the same time that was previously taken with the easy cases. They also make the point that a lot of easier work also comes with revenue for general practice as a business in multiple global settings; if that income is diverted into the coffers of technology companies, then there needs to be thought as to how to stabilise a primary care service that is provided by many small businesses. Interestingly, what they fail to grasp in this thread is the relational aspect of minor problems as an opportunity to get to ‘know’ a patient, and also as an opportunity for proactive rather than reactive care. ²

I have a sense of sadness at the implication that this is necessary for the survival of family medicine. Such quibbles notwithstanding, this book offers an elegant manifesto for digitally assisted general practice that stands alongside other recent books. ³ It is written with a BJGP-esque audience in mind.

“… the discharge summary of a febrile baby states that the child doesn’t smoke, drink alcohol, or take drugs, and that the child’s sexuality is unknown!”