The humour of David Walliams’ character Carol Beer is all human, of course. “Computer says no” would never work if an actual computer said it. At least the hapless customer can try to reason, to get that look from Carol.
So when an actual computer says no to your patient in their time of need, it’s a punch in the face.
Let’s say you have pain in your hand (arm,, shoulder, hip, knee, ankle, foot, it matters not). It’s been there over six months, came on gradually, still mild but you decide you are going to do something about it and see the GP.
You put all this into webGP/eConsult, as you can’t seem to get through by phone. Then it asks:
Did the pain come on after an injury?
Yes No Not sure.
Honestly after six months it’s not at all clear, so “Not sure”
Computer says no.
Up comes the big red box listing six things you should do, from “seek urgent medical advice” right up to “go to A&E”. The one thing you can’t do is carry on with the eConsult. It stops right there.
Now I’m not suggesting that A&Es are filling up with cases of mild hand pain of uncertain origin over six months old. Most patients have far more sense. But who do we have to thank for this sage advice? Drs Clare Gerada, Arvind Madan, Murray Ellender and co at Hurley.
At the last count some 212 of what they call “red flags” were embedded in eConsult, sometimes as subtle as the difference between scoring pain at 5 or 6 out of 10. It can be a superhuman challenge to navigate your way through a questionnaire to reach the submit button.
“Red flags” are touted as a safety feature, but of course there is logically no way to cover all red flags for all patients in all circumstances. Any reassurance we may feel is false. Yet thinking you are wearing a safety belt, when it’s made of paper, is itself dangerous.
The one thing patients don’t have is patience, and this is the killer with red flag thinking. When the computer keeps saying no, patients won’t bother again, they go back to pleading with a human, however stressful. This is at the root of the study finding, “Online consultations don’t save time or money” where 36 Bristol practice running eConsult moved just 0.16% or 1 in 600 demands online, and this most commonly for admin issues.
As you know we have an interest in this through askmyGP, but our thinking is driven by the evidence of “what works?” We have to enable GPs to be much more efficient, and while online consultations can be a part of this (GPs tell me they save 3 minutes with each one), they only work if lots and lots of patients use them.
We’re up to 30% so far (see Concord case study), and we’re working on 50%. That will only happen if we welcome all patients, all problems, we give them a great service, and we find that patients want to help.
Computer NEVER says no.
PS You can try askmyGP as a patient on Bramley Demo Surgery. It’s simple because we tried clever and complex and it sort of worked, just not well enough. If only we’d realsed sooner! Anyway patients and practices love the new simpler version, and it’s focussed all our efforts on GP productivity.
PPS If you can’t get enough of Carol’s “Computer says no” you can see her with German subtitles for extra giggles.