The future of the doctor’s waiting room

General practice has a very long way to go to catch up with the innovation that is taking place in many other trades.

General practice will face challenges – increased information access and awareness of patients (patients shall remain ‘patients’ until such time as they take control of their health), new chronic autoimmune diseases, environmentally based health issues, and increasing exacerbations of psychological and psychiatric events. This is all in addition to an increasing number of paramedicals picking the low-hanging fruit of health care and disease management, thus altering the remunerative structure of the current models. A significant pressure that will come from the District Health Board is to devolve some of the responsibilities to primary care.

The patient experience needs review from the patient’s perspective – not the GP’s.

Most diseases we see in adulthood arise from lifestyle and environmental pressure. Some, however, are trauma and acute single disease illnesses that are preventable, but lifestyle education is important here too.

A good place to start change would be with the premise that there should be no waiting rooms – no more toxic waste dump sites in which we place our loyal clients.

Think about it…

Your process should start the algorithm with the following question: is this a chronic issue or an acute issue?

These are two quite different pathways and distinguishing between them would allow for efficiency and economy of process. We observe daily this conflict in our public hospitals – where medical staff try to cater to both needs in a single entity.

The process for the acute pathway could start off with contact from the patient through a variety of media (including by phone, apps, PC, websites, etc.) or personal presentation. Regardless of the form of contact, information would of course be required. There are numerous ways for this to occur so let us assume that the pathway is robust and has the information that you or your avatar/healthcare PA requires to provide a healthy outcome.

As GPs, we should try to move away from the ‘pill for an ill’ mentality and develop more tools for our management toolbox. These may include efficient redirection before the patient is seen in person – online redirection to a member of your team – a clinical pharmacist, counsellor, clinical physiologist, nutritionist, epigeneticist, social worker, occupational therapy provider, care coordinator, health educator, prenatal educator, midwife, etc. Information and solution may then be given without presentation to the clinic – via your personal avatar/healthcare PA or with your virtual self as part of the team delivery. As part of the patient redirected contact or any other solution, you may wish to include a virtual contact with a specialist to assist in the assessment and management. This would require some thought on the secondary care medical personnel’s part.

Let us assume the individual, after IT assessment, requires or chooses to be seen. Remember this is in the acute contact pathway.

If you know it is trauma, then members of your nursing team or yourself will be involved. You would already have a trauma approach worked out, with the most appropriate triage personnel leading.

Your patient would be met at the reception by the appointed member and taken to a conversation room adjacent to the acute suite. This would be a smart suite tailored to the requirements of the client.

All costs would be collected along the way, with ACC (Accident Compensation Corporation) co-payments automatically claimed. As part of your practice registration, your patient may have chosen to take general practice accident cover in addition to ACC and would have prepaid by, for example, a membership model. Rebating for non-claims history may be applicable and could be an incentive for practice sign up and maybe lifestyle changes. All follow up would be determined and plans set up and implemented by the avatar/HCPA (Health Care Personal Assistant).

Other non-trauma acute presentations could be handled through similar predetermined flexible pathways and issues resolved in a similar fashion. The avatar/HCPA would institute metabolic near patient testing where indicated, which would increase accuracy of diagnosis and hence treatment. PCR (Polymerase Chain Reaction/antibody-testing) blood tests would reduce the use of antibiotics, etc. and for example blood pressure and other haemodynamic measures through wearables (personal devices modelled on the common fitness trackers worn like watches by many people these days) may reduce unnecessary interventions and medications. The contact may end there with the loyal client being satisfied that the acute problem would be resolved without intervention, or that a simple recommendation and avatar prescription (either pharmaceutical or lifestyle) is all that is needed. The avatar would arrange a follow-up appointment.

All information would be recorded.

Given better near patient testing – which may include instant PCR (Polymerase Chain Reaction/antibody-testing such as for COVID-19), CRP (C-Reactive Protein/inflammation), TnT (Troponin T/heart muscle cell), IL-6 (interleukin 6/marker of immune system), D-dimer (Thrombus/blood clot), and other blood work – you could make a logical management pathway. Your GP suite would include all gear on a mobile intelligent vehicle that could best position on command, all linked to your PMS (Practice Management System) by Bluetooth and speech recognition.

All related future contacts for this problem could be recorded, which would allow sensible tracking and auditing for funding negotiations.

The second scenario is if the contact is highly predictable and non-acute and is likely to relate to ongoing chronic condition management. Your loyal client would have been online and made that decision about who or what they would like to engage with. They would have a set management plan and would have access to interact with that. They would have access to health pathways and may, when the system develops intelligent interface, conduct their own secondary care triage. The development of wearables in the data collection – which would automatically transmit to your database if the patient so requests – would greatly enhance this capability. They may have chosen to do an online consult with the triage avatar and then decided to choose a team member for a virtual consult.

This would allow flexibility of workplace and may suit a range of practitioner lifestyles. It would also give flexibility to the patient and respect their lifestyle.

Your current real-time analysis of workflow would allow continued refinement of the time management and if in the unlikely event of a hiccup in workflow, an IT contact with the next client could advise that they have time for a coffee whilst watching a suggested YouTube clip, or else the information collection via the online avatar contact could get started.

In a broader context, targeted education could be broadcasted to your patients as well as reminders to follow instruction, and also the ability to show an ongoing care connection from your clinical team would all be very much the way to induce lifestyle changes.

Fantasies…… Fantasy is the beginning of a new reality. The end is nigh for the waiting room but not for a future-seeking General Practice.

You as a practitioner would now have control of your day and your life, and would be able to give a more comprehensive and useful programme to your registered population.