/ Health, Home & Energy, Technology

Would you use an online doctor?

With waiting times in doctor’s surgeries on the rise and people increasingly moving around the country, it seems likely that online doctors could become ‘a thing’. But would you ever use a digital doctor?

Last night an advert on the train caught my eye; it was for online doctor appointments. I know the internet is full of advice, some expert and some questionable. So this got me thinking – would I ever use an online doctor?

Not being familiar with the concept, I decided to find out what it’s all about. A quick Google showed plenty of sites advertising the ability to speak directly with a doctor online. There were even recognisable high street pharmacies with these facilities on their website.

Maybe I’ve been blind to this digital medical revolution?

Is there a place for digital doctors?

We seem to be getting ever more interested in tracking our health, with the rise of health apps and connected health devices like FitBits. Interestingly, a poll conducted last year revealed that GPs were concerned that the growth of smartphone health advice would lead to an increase of the ‘worried well’ lingering in their waiting rooms.

And then there’s the increase in online medical ‘services’, such as buying medicines online and online allergy tests. Neither are necessarily to be recommended, but both seem to have a steady flow of customers.

The news is regularly reminding us how waiting times are increasing in our surgeries, and how precious doctors’ time is. I’m certainly conscious of the expected waiting times at my surgery, which is why I’ve attended walk-in centres for medical attention.

But I do think that we’re getting more impatient with our expected waiting times. Is this down to modern-life time constraints, or is there real demand for instant, accessible, specialist advice online?

Digital: the next step in triage?

Growing up, I had the same doctor until I left home. Ok, I rarely saw my GP when I was living at home, but I still had a good relationship with him; he could remember administering my first jabs and the time my poor mum turned up with both her tots covered in chickenpox.

Since moving away from home, and despite having registered with my local surgery, I’m yet to see my doctor. Of course, this is a good thing as it (hopefully) means I’m healthy. But I do use Google every now and again if I’m concerned about anything, and I have plenty of friends with children who use digital advice before a trip to the doctor.

So I wonder if digital doctors are the way forward for us? A sort of triage approach to dealing with our niggles, reducing the pressure on surgeries and satisfying our needs for instant answers.

But, for me, there’s more than adequate justification for physically seeing a doctor; there are some things that I don’t think digital advice can achieve. After all, there’s a distinct difference between a nasty cold and a longer-term and complex illness. And being able to spot the difference between the two is something a digital doctor would struggle to do.

What are your thoughts on this? Have you ever used a digital doctor, or can you see any circumstances where you would be happy to try one? Maybe this trend will just create a rise in the ‘worried well’, as GPs seem to think…


At present I use a very efficient GP practice and have no difficulty in getting appointments on weekdays. They do offer pre-booked appointments on Saturday too but I have never booked one. Repeat prescriptions can be ordered online and picked up at the local supermarket two days later or when I’m next shopping. On three occasions since moving to this practice I have been referred to specialists and that has been handled very efficiently. My GP surgery is a fifteen minute walk or 5 minutes by car. I feel very lucky and would not even think of using an online GP.

I’m planning to move home and I will have to switch to another GP and know I will have to travel several miles to attend appointments, but I need local advice on which practice to sign up with. I have friends in the NHS and have had useful advice over the phone in the past, so I don’t discount the idea of using an online service. For example my GP drags me in for regular medications checks and asthma checks and the answers are always the same. I am strongly in favour of medication checks because they provide the opportunity to cut down on unnecessary medication, but in many cases this could be done online or on the phone.

In some parts of the country there is a chronic shortage of doctors and online doctors may help ease the problem so that everyone can see a GP face-to-face when necessary.

The BMA and the Government say there is a shortage of 10,000 GP’S in the UK, but the majority of GP’s are female and a fair proportion only work part time, only doing 2 or 3 sessions a week, if they worked a full 5 day week there would be less of a problem!!!

Iain T says:
6 February 2016

In the knowledge that there is a shortage of GPs, many have chosen to work less hours for less pay. One can only presume that working more hours for more pro rats pay just isn’t worth the increased stress. How would you persuade a well educated mobile professional group of people, who have qualifications allowing them to work in any 1st world country, to work more shifts for the NHS?

Jack says:
1 March 2016

And what is your point?

Only yesterday was I told that a GP was driving from Swindon to either Bridlington or Scarborough, which is a crazy waste of resources.

I don’t know how or if you can persuade GPs to work full-time or work in areas where there is need. At one time I knew a GP who moved from working in pleasant residential area on the outskirts of a city to a difficult inner city area because he wanted the challenge and to make his mark. I don’t know how long he held down that job but I see he is now working in what I recall is a pleasant area, just along the road from a well respected independent school.

Every one of the GPs at my practice is part-time but the practice is open to new patients and there are other GP surgeries in the area. Some were working only four sessions a week but this has changed and a couple of them are doing eight sessions plus covering Saturday mornings by rota.

I think you live in a fairly affluent area which doesn’t have an industrial heritage, a big dollop of long term sick benefit claimants, people living in poverty or eating unhealthy diets and drinking too much alcohol. it’s a bit of a different story up here in the North east.

Seven years ago, aged 62, was the last time I had an appointment with my GP, when I had been ill for several weeks. He quickly arranged all sorts of tests which ruled out suspected cancer, and I eventually returned to full health , for which I am grateful, and also appreciate the efforts my GP made on my behalf.

In the intervening seven years I have only twice tried to get an appointment at the surgery and failed on both occasions, instead receiving a consultation once over the telephone when my GP called me back the next day. The surgery has adopted the practice of not allowing patients to book ahead for a face-to-face appointment; to do so the patient must ring in every day to see if there is an appointment available … .. with ANY of the GPs.

I am fortunate to enjoy good health, but this may not be the case in 5, 10 years or so. I feel I must no longer rely on my local GP practice, 4 miles distant, but must rely more on my own efforts.
I do not have private health insurance but recently paid for a full check up at a private clinic. I will probably do this every other year, as it was a bit pricey to consider it annually. If the need arose I would certainly take advice from an online doctor service and, yes, would expect to pay for this service.

wavechange is fortunate to have such a good GP service. If I were in his/her shoes I think I would be prepared to travel back to my old address for consultations with my existing available doctor.

I presume that not offering advance bookings is because of failed appointments, but that is hard on those who behave responsibly.

I would be very happy to continue to use my present GP practice, which I chose on the basis of recommendations from neighbours, but the nurse who did routine tests last week thought that I would have to move. This is presumably because of the travelling time if a home visit was needed. I cannot recall having had a home visit since I was a child – but we are all getting older.

It’s no doubt also because the Practice lists are getting full and, after you have moved, one or two more people will be living in your house and needing to register with a local GP. I would have liked to have continued with my previous GP after moving but the Practice would not allow it; on the other hand my wife was glad she did have a new GP.

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Good point Duncan. I would want online services to be run by the NHS, like the current NHS 111 service and the service I use to request repeat prescriptions.

It might depend on the problem I had at the time of need

Simon W says:
6 February 2016

I’d be interested in online doctors. With quality of video calling going up and the ubiquity of the Internet ever increasing this could surely take a huge strain off the NHS. I’d like to see a service run by the NHS, staffed by NHS doctors rolling through easy diagnosis cases in minutes and issuing prescriptions remotely if necessary. I write this sat in an out of hours gp surgery in the hospital, waiting to see a doctor so he/she can write my son a prescription for conjunctivitis treatment. We know the problem, but you can’t get over the counter treatment from a pharmacy without prescription for a child under 3. Therefore this whole trip to hospital /gp is unnecessary if he could be seen remotely by a competent health care official and the correct prediction emailed to me to print /show on my phone to the pharmacist. In 2016 there has to be a more efficient way to do routine visits /diagnosis than the way it is currently.

There are security implications in emailing prescriptions but they can go directly to the pharmacist. My repeat prescriptions are collected by Tesco and always available for collection two days later. Waiting rooms are a great place to spread colds and worse.

Unfortunately, the hassle of seeing a GP helps cut down the number of GP visits and I fear that a convenient online service could increase demand on time and expenditure on unnecessary drugs. Maybe we need some input from GPs.

We must be so fortunate………….
A number of years ago my then lifelong health centre went fundholding
After a number of years my wife as we would say here lost the plot at not being able to get appointments for sick children……………
We had a named Doc but never got that Doc………….Getting an appointment was a few days or more often next week……………..rubbish service
Anyhow she moved us to another village centre to more people we knew
That health centre never went the funded route
We get to see our own Doc just as long as we get a appointment on his/her days and we dont have to wait a day or two let alone a week
If we’re really ill we can have an appointment same day usually with a choice of Doc
The local Pharmacy (Boots) sends a girl to the centre twice a day to collect the scripts
They have no high paid “manager” yet can get by
No one ………Doc’s Nurses or reception are ever rude or seem under pressure
The car park has nice Doc’s cars but just nice………..no high end Merc’s, BMWs
One Doc likes to play at farming and has a Disco and it looks like a farmers wagon

It is SSSSssssoooo good in comparison to our relatives and friends

Bet thats a surprise,,,,,,,,,a post from DeeKay that isnt a gripe
It can be done………….

Our daughter in law now works in my wife’s old health centre…………..Bad pay,,,,,,,,,,They wont spend money on staff and everyone has a face like thunder as we would say

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Compliments Duncan…………..Millionaires……………removed from reailty

Unfortunately consecutive governments over the last 20 years or more have been slowly privatising the NHS right under everyones noses. Now it’s a policitcal hot potato , more so since the poor junior doctors jumped on the wagon.

Many of our emergency ambulances are run by St Johns and quite frankly they’re not equivalent to paramedics. In addition, in the NE the ambulance services use volunteers to attend (in their own cars) 999 calls from people’s homes to be with them and provide basic first aid until the ambulance gets there. Quote from the North East Ambulance Service website

“A First Responder is a volunteer who has been recruited and trained to act on behalf of the North East Ambulance Service, responding to emergency calls when dispatched by ambulance control. They will deal with a specific list of emergencies and provide the patient with support and appropriate treatment until an ambulance arrives.
They exist in towns and villages where it may be a challenge for the emergency ambulance to arrive within the crucial first few minutes”

The NE has one air ambulance which is a charity. That’s despite the fact that Northumberland is the 2nd largest and least densely populated county in the country.

Roger Hill says:
6 February 2016

Patient.co.uk is a very good online service for non-emergency things e.g. bad backs etc. It is free and is run by GPs and consultants. The “check your own health” facility is very good too and has a good email based follow up checking service.

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As a former GP, now retired for nearly 10 years, I see this as an extension of what we were doing in the “out-of- hours” doctors’ cooperatives, which existed before being replaced by NHS 24 and NHS Direct. This was a doctor-led, doctor-staffed service, where a lot of history-taking, diagnosis and triage went on over the phone. Of course we made house calls if the situation suggested that was needed then and there, or ordered blue light ambulances when deemed necessary, and we saw a lot of patients at the health centre itself. Not everyone got seen at night or weekends: many oatients were happy with advice given, or able to wait to go to their own surgery for the next available appointment.
Now you can use email, possibly even see patients directly via Skype or FaceTime, which could be of further help in diagnosis, especially for physical signs such as rashes which patients often find hard to describe over the phone.
We got used to being criticised for not being able to see everyone instantly: appointments were often wasted by people not turning up or not telling us they no longer needed them, sometimes, incredibly, even those booked on the SAME DAY! We got further “beaten up” for not providing appointments going on into the evening and shutting our doors at 6pm and handing over to the out of hours cooperatives: but we weren’t at home having a gin and tonic: oh no, usually still in behind closed doors until at least 7.30.pm catching up on results and correspondence, having been there since 8am. No time for coffee breaks or lunch, just throw a sandwich down your throat in between patients if you’re lucky. Oh dear, I was part-time too, but did more hours’ work per week than most people in full-time jobs: and no, I didn’t get £100,000 per year for it or anything like, as was the myth perpetuated by various politicians and the media then. So no wonder I retired at 60, as soon as I could get my pension. Loved my job, and at least some of my patients, but enough was enough. As far as I can see, things have only got worse in the last 10 years, despite many great medical treatment advances, and if the NHS is not properly funded nor can meet with the staffing demands placed on it, then online consultations will have to be part of it.

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The Guardian is looking at world health systems – this is the worst of the bunch examined:

” Upfront payments: yes
Data: the US scores poorly on many fronts, ranked 11th out of 11 in the Commonwealth Fund 2014 list. And yet it far outstrips all its peers in terms of the amount it spends on healthcare – a whopping 17% of GDP.

US healthcare is not quite the Darwinian lottery imagined by foreigners. Hospitals are duty-bound to treat emergency cases. Government spending pays for a surprising share of visits to the doctor and drugs through a patchwork of public programmes: Medicare for the old, Medicaid for the poor and Chip for children. Since Obama’s insurance reforms, the percentage of people who have no cover has fallen to “only” 10% – a mere 33 million people.
For the rest, standards are generally high, sometimes among the best in the world. But no matter how good the insurance policy, few Americans can escape the crushing weight of payments bureaucracy, or the risk-averse medical practices that flow from a fear of lawsuits.
Almost all visits to the doctor (often a specialist, rather than general practitioner) will generate “co-pays” for the patient and revenue streams for the physician that some fear encourages excessive testing and intervention: a consumer, rather than care-led, culture.
Preventive medicine and public health are harder to incentivise. Patchy access to insurance can leave emergency rooms clogged with chronic conditions. Obesity and mental illness often go entirely untreated.
Though the system fosters excellence and innovation in places, the messy combination of underinsurance and overinsurance has left the US with the highest healthcare costs in the developed world and some of the worst overall health outcomes.”

Perhaps a comment from the Govt. on its aims …..

BTW the UK comes first in the report which can be read here:

Thanks for that. I’m not sure if I believe all of this, but it makes interesting reading.

We must not further privatise the NHS or we might need to use websites to compare tariffs for doctors’ services and medications. Maybe we will have standing charges, cancellation fees, discounts for families. If you think that can’t happen, just look at what has happened with gas and electricity pricing in recent years.

Thanks to bean counters we have cut back on cleaners in hospital wards, told nurses to wash contaminated uniforms at home and made no provision for parents to park their cars without having remembered to bring coins, if they run their kids to A&E.

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We been through this before……………Yes Duncan,,,,,,my wife works in Renal…..They have all the usual bugs and spillages and as would be obvious working with blood and fistulas as so forth there is the regular stain………..There is C Diff and regular bay deep cleans but they dont deep clean wifey or her clothes
Yes they have plastic aprons which help but do not prevent……..
It should never have happened
Managers and big flash cars dont go hand in hand with good healthcare
What did we even do without these people way back!!!!!!!………..How did we survive without them!!!!!

Agreed Wavechange. It’s an unwritten law that any charging structure that can be Salami-sliced will be eventually. Already, Primary Care Commissioning Groups are starting to de-list procedures that will be funded by the NHS and there doesn’t seem to be any public accountability about this. Newspapers have to resort to FOI requests to find out, it is usually resisted, and if any disclosure is made it is the bare minimum.

The NHS absorbs money like a sponge soaks up hot water. What good has the extra £8 bn made available by the government done so far? There must have been some progress but it never seems to be visible. How much more should we spend? – Another £10 bn? . . . £20 bn? At what point would we see a real leap forward ín healthiness and better treatment?

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If asked whether their hospitals should come under the control of “the Virgin owner” or a bunch of anonymous bureaucrats, how do you think the British public would vote?

The populist view seems to be that too much money is spent on NHS administrators. When consultants and others involved in delivering services say the same, I’m inclined to believe it’s true. It is tremendously difficult to decide how best to spend money in the NHS and I don’t see an easy solution.

Duncan and DK – Where I worked, all staff lab coats were sent to a laundry for washing at high temperature and pressing. Staff who worked with hazardous organisms in the containment lab had their lab coats autoclaved – at 135°C before sending to the laundry.

I don’t claim much knowledge of the dangers of the infection risk in hospitals but Clostridium difficile is a spore-forming organism and bacterial spores can survive very high temperatures.

The NHS has been providing “better treatment” since it’s inception, and that’s the problem. Medical science has improved dramatically in the last 20 years in particular and we’re finding more and more ways to treat people every day through excellent research (which all has to be paid for). A lot of the new ways of “better treatment” involve very sophisticated machinery . 10 years ago MRI scanners weren’t available at all General hospitals. And we have an ageing population and a HUGE drug and alcohol problem. 25 years ago most Intensive Care Units had an age cut off of about 65. Now we have more people who need preventative medicine (another example of “better treatment”). The NHS was never designed to do what it does now. It will continue to eat up billions unless we have some sort of a pay system, or we stop treating some people. Oh and if they’e going to keep increasing the nimber of Drs employed then they need to keep increasing the number of nurses, AHCP and support staff. Not rockey science.

Regarding nurses and the requirment that they was uniforms at home in domestic machines that may well be designed not reach the required temperatures that are indicated on the dial. I take this list from the 98 page review of all data available on washing clothes by IFH:

Some of the circumstances no doubt will apply to some of the readers here:

Category A. Higher risk items
Category A1
Specific items of clothing, household linens etc. where there is considered to be a higher risk that they may have become contaminated with pathogens or antibiotic resistant strains during normal daily use or wear including:
• Uniforms of healthcare workers and clothing of other workers who are likely to come into contact with pathogens, which are laundered at home e.g. restaurant, laboratory and sewage workers, veterinarians, farmers, etc.
• Clothing of family members giving care to infected family members
• Clothing etc. which is heavily soiled e.g. with faeces or vomit, or body fluids (including reusable babies’ nappies)
• Sports clothing, particularly high-contact sports such as rugby football, American football, martial arts, etc.
• Cloths and towels used in the kitchen during food preparation, the nursery etc.
• Clothing of patients in hospitals, which is taken home by the family for laundering
• Clothes of patients with chronic wounds (up to 1 – 2 % of every old people will have chronic wounds which can be heavily contaminated with Staphylococcus aureus and Pseudomonas aeruginosa)
• Clothing of family members with skin diseases such as dermatitis, who may be heavy shedders of e.g. S. aureus
• Fabric items associated with domestic pets e.g. pet blankets.

I think you have highlighted the key issues Linda. The significant words are “or we stop treating some people”, and this is hard to come to terms with. Opthalmic services for adults up to sixty was the first big withdrawal, dental treatment has become very difficult to get on the NHS in some parts of the country, and we are generally being made to feel guilty for living so long [despite the NHS!] and blocking up the local surgeries and hospitals. Difficult or expensive procedures could follow, or alternatively simple and economical treatments that people might fund themselves through membership of a private healthcare scheme or insurance with only those on benefits or state pensions able to have free [or subsidised] treatment.

Deterrence is a passive method of suppressing demand – make the conditions or the waiting time so unpleasant that many patients take their illness elsewhere. This is not so much privatisation [the vast majority of the enormous number of clinical staff and practitioners are still employed by or under a contract with the NHS] just a continuous and unrelenting withdrawal, and yet there is no process in which the general population can participate in this tendency and influence the decisions, especially the balance between the high-end surgery and non-essential procedures for the few and the routine treatment of the many.

As you say there has been massive progress in virtually eliminating many conditions and infections, prolonging the lives of many who even thirty years ago would not have survived, restoring people with horrific injuries that would previously have been fatal, as well as pioneering and developing advanced treatments and procedures making use of extremely sophisticated technology. So how do we choose what the NHS should and should not do within the ever-increasing allocation of funding that still does not seem to keep pace with the inexorable rise in demand?

My GP practice has been taking blood samples for tests since I registered and now includes the HbA1c which is a useful way of screening for diabetes. According to the nurse who took a blood sample recently they have identified many with diabetes since introducing the test a couple of years ago.

I don’t know whey GPs were not screening for elevated blood glucose long before the HbA1c test became available. A simple blood glucose test is not as good as the HbA1c test but could have enabled many to learn that they had elevated blood sugar in time to take prompt action.

Having routine blood tests to check that all is well is a good enough reason to visit a real doctor. Hopefully that is the advice of online doctors.

The way forward must be to use digital advice where it can be of most use and take the load off our GPs. As I see it, the medical profession must be the driver.

As has been pointed out by many people, the NHS focuses on dealing with medical problems rather than preventing them. Perhaps this is an area where digital advice could offer positive help. Having a smartphone that tells me how I have walked in a day, week and month has certainly encouraged me to take more exercise.

They were (or should have been!) checking for elevated blood glucose before the HbA1c became the recommended test for screening for and monitoring of Type 2 Diabetes as part of the Prevention of Heart disease and Stroke programmes which came into being at least 15 years ago. Again, annual routine screening and monitoring could be done very effectively by Nurse Practitioners.

Having recently undergone major surgery I might be in a useful position to speculate on this proposal.

I’ve long thought using a digital doctor might be a useful way of freeing up surgery time, speeding up diagnoses and generally making life much better for both patients and doctors. But it’s not quite that easy.

An Expert system (which is one significant aspect of what is being suggested) has been employed for years in fields where diagnosis of relatively simple issues is needed, often at a distance. Engineering, for instance, uses systems which employ types of AI and have done for many years. But the reality in medicine is that in spite of tremendous efforts by many groups of physicians and computer scientists all over the world, no one has yet succeeded in developing an expert system for medical diagnosis that has been adopted for widespread use. The question, therefore, is why not?

This difficulty in developing diagnostic and decision-making computer programs is in sharp contrast to the rapid incorporation into medical practice of certain classes of computer programs that are very useful to physicians as aids to decision making. For example, major contributions of computers to the technology revolution in medicine have been made through modern imaging techniques such as computed tomography and magnetic resonance, so it would appear that doctors – and in particular younger doctors – are more than willing to use assisted diagnostic differential programs.

But diagnosis (as has already been alluded to) is not an exact science, especially when some diseases can appear – from their symptoms – to be something very different. There’s another issue: expert systems normally rely on experts using them for the best results. This proposal would rely on patients using them, and I suspect I’m not alone in seeing that as a major impediment.

All Expert systems rely on a comprehensive database to function, so it’s worth looking at one specialism – Haematology – to see how easy or otherwise the creation of such a database would be.

In one such Expert system the Doctor can input signs, symptoms, and laboratory findings chosen from a list of 667 such findings relevant to 142 haematologic diseases; an ordered list of possible diagnoses and, if requested, indication of findings which support or contradict these diagnoses; a list of additional tests or procedures to confirm or to rule out any of the diagnoses; and update of possible diagnoses after receiving additional real or hypothetical information on the patient.

That last is crucial, because an Expert system has to be able to learn. If it can’t learn, either because too few Doctors are wiling to spend time training it or because of a perceived lack of competence, then it will be largely ineffective.

And I suspect this is where the first stumbling block will arise. If we have any doubts about the 111 service to render accurately targeted recommendations then our concerns about digital doctoring should be much stronger. But, as I said earlier, the biggest concern is the inputting of information. In the main, this would be done by the patient and I can’t be alone in viewing that as a potential disaster. And I’m still unsure as to how the computer would palpitate my spleen…

Great to have you back Ian – I hope you are in good shape.

Thanks, John. Just back from a 1.5km walk over the hills. May not sound a lot, but today marks the 3 week period since the op, so I’m happy with it, anyway :-)).

Ian mentions engineering and the use of expert systems which gave me a slight twinge. I am fairly sure thta the lovely millenium footbridge that swayed dramatically over the Thames was the product of intelligent people and computers.

That they magnificently proved themselves wrong and it required a substantial reworking is not encouraging.

The human is so much more complicated and variable that I have my doubts how far an expert system can go in diagnosis. Whether we can reach a state where the melded information on bloods , vitamins. minerals, etc can assist doctors I think much more possible.

In my experience some “9-minutemen” GPs are pretty useless – I won’t mind them having better diagnostic aids, if it led to fewer patient deaths, from failures to correctly diagnose life threatening conditions early enough.

Good to have you back, Ian. Diagnosis is certainly one of the problems. Search for ‘differential diagnosis’ for examples of some of the problems that GPs face in interpreting symptoms that could have various causes.

One way that a ‘digital doctor’ could help is to keep patients with infectious diseases such as colds and flu out of GPs surgeries. During the swine flu outbreak in 2010 I was very ill. The information available online was very helpful and I realised the importance of keeping away from others. In order to get treatment I had to ring NHS Direct (Now NHS 111), go through a series of questions that I had already read online and get a neighbour to collect the prescription.

But if we’re talking about freeing up surgery time and reducing waiting times for diagnosis of everyday illnesses then I don’t think the main issue is the actual diagnosis. Motly I hope that armed with all the information Doctors and some other healthcare professionals can diagnose fairly accurately without CDDS. The main issue is the method we use to obtain all, or most of, the information required for safe and accurate diagnosis whilst freeing up GP and GP surgery time,.
In my opinion, and I’m sure the opinion of many Doctors, accurate diagnosis relies on almost all of the senses and a physical examination. A good CDSS relies on the input of , as you say, signs and symtpms. Symptoms are something the patient reports, but signs are something the professional detects. Just like a medical professional, no CDSS can give an accurate diagnosis without most of those and when specific things are input, for eg, Chest pain, numbness, pins and needles, shortness of breath, any good system will spit the patient out,so to speak, and say they need to visit a Medical Profesisonal. Another problem is that Past medical history is a major piece of the jigsaw puzzle and some patients are notoriously difficult at providing an accurate history of their current and past illness and takes a certain amount of skill to obtain this. This is especially true of the elderly with have multiple chronic conditions and what we call polypharmacy ie they’re on a lot of med’s. Without access to medical notes then it all becomes a bit of a minefiled. I am betting that the online servcies that are available at the moment have some clause in the small print regarding liability.
My Mother who’s 78 had a productive cough after a head cold last year . She appeared short of breath , had a bit of a wheeze and looked a little unwell and probably had a low grade fever, but was up and about and doing her usual things if a little more slowly than normal. I listened to her chest and she had rattles in the base of her lungs and and a wheeze. She called the Doctors but they had no appointments and said the NP would call her later. He did, and prescribed antibiotics but didn’t offer her an appointment to come to the surgery. I told her to call back and ask for the first available appointment. After 2 days of antibiotics she was no better and possibly a little worse . When she visited the GP they listened to her chest and did her pulsoximetry etc . They told her she had “bronchitis” and gave her a short course of steroids, a different antibiotic and an inhaler to help with the shortness of breath. I’d already told her to use my Father’s inhaler if she got wheezy and short of breath (please note, I would not generally advise that someone takes another persons prescription only med’s) Elderly people need early appropriate treatment for chest conditions and in this case if I hadn’t intervened and told her to get an appointment to be seen, she could have ended up in hospital with pneumonia.

I think the real issue is that the Expert systems are available in a rudimentary form already but will require thousands of hours of feedback from GPs using it in live situations to ensure its reliability. That – I suspect – is where the problems will lie.

Phill says:
11 February 2016

I’d have to be convinced that it was a real doctor and not one of the multitude of quacks and conspiracy theorists that infect the ‘net.

The BMA is the doctors’ trade union. The Royal College of Physicians or the National Institute of Health & Clinical Excellence might be more appropriate, or even the relevant NHS Clinical Commissioning Group.

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A lot could be achieved by having surgeries run by Nurse Practitioners who are very capable of doing at least 50% of what GPs do at about one third of the cost. Over and over again, research has shown that patients are more or just as satisfied with a NP, or indeed a Clinical Nurse Specialist, in both Primary and Secondary Care. NPs are also quite capable to undertake roles that were traditionally done by mid -grade to senior Doctors. If the NHS wants to reduce costs then they need to look at different ways of delivering care without compromising quality. I’m not in favour of telephone consultations. The backbone of medical examination is Look, feel, listen. How do you do this over the phone.? NHS 111 is a sham and NHS Direct wasn’t much better. I remember when it was first set up in 1998 the CDSS they were using didn’t have an algorithm for stroke.

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We lived in the USA for 5 years and both of us worked in Healthcare for the same “not for profit” sizeable Healthcare provider. My husband has a background in Healthcare Research (MSc) and Accountancy and Finaance and he had a job where he combined his two hats.The problem with the majority of Americans is that they want to be seen immediately, for everything and anything. They want testS and drugs becasue that = great healthcare. They want their yearly colonoscopy under General Anaesthetic .They want a private en suite room in a hospital with a Starbucks in the lobby. They don’t want to know about the people who have no insurance, or are suffering because they can’t get care or can’t pay their bills and risk losing their home. They’ve perpetuated and fed the big ugly monster known as the Healthcare Industry in the USA. They’re shocked if you teel them that there are 6 patients in one room and that in a mixed sex ward there are only 2 bathrooms. As for here, to be fair, succesive governments over the last 15 years have been slow;y moving the NHS towards privatisation and encouraging a 2 tier system. The system would work a whole lot better if they increased the numbers of support, allied health and nursing staff by at least the same percentage as they’ve increased the number of Doctors over the last 10 years. Glad to be out of it but I do dread myself or anyone in my family having to go into hospital.

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Useful stuff Linda – particularly on the Nurse Practitioner route.

I was looking at the best the RSPCA is in and in a way it has similarities to the NHS. Cleverer technologies require money but allow more “saves” . And of course mission creep where rabbits are now also housed and hopefully homed!. Seven hundred horses housed at £100 per week.

There needs to be a clarity in what is emergency medical care and what is optional -” would’nt it be nice treatments.” And old age-related ailments should be a completely stripped from being the NHS remit so clarity can be gained. The breakdown of family structures, such as children looking after parents is perhaps one of the real downsides over the last 70 years.

Whilst many families parents and children probably love the idea it is an expensive selfish concept in a time of normal economic times afterthe post-war boom made everything “by the State” seem possible. Or finally will there be a realisation that getting older people to stay alive longer and longer is actually a problem.

My father was kept alive expensively two years longer than necessary. To suit whom? An NHS ethical qualm.?

Whilst we can tinker with the NHS and remote doctoring the big problems need to be faced.

No, I disagree strongly. It’s the actions of NHS that has resulted in people living longer, therefore they need to provide healthcare for them. The elderly already get a raw deal. As for “the breakdown of family structure”, 70 years ago people weren’t living as long and most women weren’t going out to work, and the elderly weren’t being dragged back and forth to lots of different healthcare appointments every month. What they need are specialist poly clinics , again, doesn’t need to be doctors, where they can access all the services they need under one roof. Some sort of coordination of their secondary care. The other thing that perhaps we, as a country, should be considering is voluntary euthanaesia. I have no desire to live to 90 with chronic pain or disability, being dependant on others for care. Yes some elderly people have very full lives, but others feel isolated and have just had enough. I notice that the incidence of suicide in males over the age of 70 is on the increase again since 2013.

I like the idea of an all-in-one clinic . I think that you misunderstand the split I am trying to orchestrate which is designed to actually make care for the elderly far more joined-up as the long-term needs are very different from an accident and emergency service.

As for voluntary euthanasia I am very keen that people are not kept alive longer than they wish simply because “that is what we do”.

Hippocrates: “To do nothing is sometimes a good remedy.” Perhaps we need to consider this beyond the simple interpretation.

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Interesting thanks for the info.

Also from the US reported this week is Hilary Clinton [and others attacking the cost of drugs. Amazingly some drugs available in the 1980’s are now far far more expensive.
“In a 30 second spot entitled “Predatory,” Clinton vows to “go after” Valeant. In the spot Clinton claims the company hiked the price of one of its drug therapies from $180 in the 1980s to over $14,000 now.
Valeant is hardly alone. Nearly a year ago we reported researchers at Oregon Health & Science University (OHSU) and Oregon State University (OSU) determination that there had been an “alarming rise” in multiple sclerosis drug prices over the last two decades.”

How the drugs bill affects the NHS budget for other services like access to Doctors is interesting. I do believe that we can have access to this information on NHS prices.

Dwight Lundell had his licence to practise medicine revoked in 2008.
In 2000, the Arizona State Medical board concluded that his postoperative management of a patient who had died following carotid artery surgery was substandard and insufficiently documented. He was censured for unprofessional conduct, assessed a $2,500 civil penalty, and placed on probation during which he was required to take continuing medical education courses in carotid artery surgery and medical recordkeeping. He was also required to submit to monitoring of his patient records [4].
In 2003, the board noted that 13 out of 20 charts reviewed by the consultant were deficient because they did not include adequate initial evaluations of the patients. Lundell was censured again and was placed on probation that included quarterly chart reviews [5].
In 2004, the board found fault with his management of two patients and concluded that his records for these patients were inadequate. He was reprimanded and ordered to serve two more years of probation, during which he was required to undergo an extensive evaluation of his fitness to continue practicing medicine [6].
In 2006, the board sent him an advisory letter for failure to maintain adequate records and for a technical surgical error [7].
In 2008, the board reviewed Lundell’s management of several more patients and revoked his medical license. The board’s order mentioned that the board was investigating his care of seven patients because the Banner Desert Medical Hospital had suspended Lundell’s surgical privileges [7].
Numerous academic articles note that what he claims is ‘new thinking’ is in fact, old ideas trotted out in new dressing. At best, his ideas are described as ‘overly simplistic’.

There may well be something in what he says: the low carb diet, for instance, has been gaining traction for years and many are now actively avoiding processed food but the crucial element is that he offers no evidence for his theories. Oh – and he charges $245 a month to subscribe to his ‘Truth about Heart Disease’ web site.

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The established view is that we should increase our intake of omega 3 polyunsaturated fatty acids – specifically DHA and EPA – and not omega 6.

Ian beat me to it concerning Dwight Lundell, but you can read about him on the Quackwatch website.

Thanks guys. The benefits of a live forum ; )

The problem is where good science is mixed up with pseudoscience. The Mercola effect.

The US, unfortunately, seems to attract failed or even dangerous medics where they seek to make a lot of money scaring people. Andrew Wakefield (whom this chap reminds me of) is another case.

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I do not consider there is anything wrong in seeking medical advice online either for a fee or free if available. I had a general question once regarding eye disease because I am diabetic. I dont think my GP would have had the faintest idea how to answer my question. I was able to put it, online to a professor of opthalmology at a US eye institute and got an unbiased reply, for free. On another occasion I sought the opinion of a qualified dermatologist regarding a skin condition, sending a photo. I think there was a fee for that but I got a very detailed response and it cost a fraction of what a face to face consultation would be privately. Neither of these were a medical emergency but it saved making appointments with my GP and I got opinions from specialists for free or next to nothing and dealt with my concerns. So a resounding yes, I would and do use online medical practitioners and would like to see the NHS develop this idea.