Dear Editor
The latest edition of the BMJ references Buxton’s Law several times (‘it is always too early until, unfortunately, it’s suddenly too late’ to assess health technology). I cannot help but think the issue misses a large elephant in the (GP waiting) room. Health technologies have come thick and fast into the world of primary care, and have been enthusiastically deployed, and I fear this is leading to the degradation of the quality and, to a degree, the remit, of generally practice, which is primarily to look after the health and wellbeing of the local population on a personal level. Much of this innovation has not been tested for its efficacy, quality and impact on patient care, and we seem too hesitant to challenge it in the name of progress.
Total triage systems, with ever increasing AI led questionnaires, mean patients are guided towards a probable outcome based on algorithmic gerrymandering. Computerisation does not account for nuance, subtlety or history, nor the inherent knowledge I have about my patient and their larger unique biopsychosocial picture. I hear from colleagues how marvelous total triage systems are because patients get diverted away from them, yet the (limited) evidence suggests it leads to an overall increase in total contacts for the same problem. Personal experience both as a patient and a relative of elderly, frail patients, I confirm that total triage is frustrating, irritating, unsatisfactory and occasionally unsafe. Supplementing it with soothing female automatons as a receptionist ‘voice’ adds to a system that is being unhelpful, soulless and irritating to come up against.
With ambient AI being deployed to take notes, colleagues say how they ‘give themselves wholly to their patient’ and are ‘so much more present’ in consultration. What on earth were they doing before, looking at cat videos on YouTube? I challenge such obsequious comments – a more honest individual might, I suspect, admit they switch off just as much and possibly more to the random warbling of the patient when someone or something ese is concentrating for them. Then you have the notes to contend with – lengthy, bland, and cold. They must be read, adjusted and accuracy ensured. How much thinking and processing time is lost by this sterile transaction and what value to human interaction does this equate to? I get far more from shorter notes written by a human, with the warmth, subtlety, and nuance only conscious thought can bring. More than one problem in a consultation – which is not the exception – and it simply cannot cope. Let us not begin to consider the consultation as a drug, and effect sure to be lost if this relentless march continues without serious attention to detail.
The times I bring this up, there are vocal advocates of AI in all its glory, saying it makes them a better doctor, filters the patients out so they only see the ones they need to see, and makes their job so much more tolerable because they see fewer patient. The subtext is the self-satisfaction at how few patients they now see, and the artificially shorter waiting times it creates – The notion that a patient can’t book more than 2 weeks ahead because the system does not allow this is not the same as a 2 week waiting time.
Are we solving the right problem? Destroying patient centered care, putting up more barriers to access in the name of technological progress, when we know the real problem is not enough doctors, and ever-increasing demand from patients. I know there are many out there who agree, but who stay quiet. Why the silence? I am not suggesting a new Luddite movement calling for breathing space and a true and honest assessment of the AI we have, how it is used and what benefit it brings before accepting it as the new normal. When I am old and infirm, I want to be able to speak to and see, a real, live, human being, who knows how to listen to me, examine me, understand me, and manage my care with empathy and nuance, compassion and humour. In short, a person, with whom I have a relationship. Supplement this with technology, sure, but don’t eradicate it. Common sense before compusense, perhaps.
Dr Hamish Duncan
Re: Hail medicine’s latest, and super intelligent, miracle cure