My senior partner can remember his wife being stuck indoors whenever he was on call, in order to answer the phone. She would have his itinerary, and would ring round various patients’ homes to track him down when a new visit needed adding to the list or something urgent had cropped up.
Pagers were the norm by the time I started, though one still had to find a phone to return a message when out and about. Before long, though, our practice acquired one of the new mobile telephones (not quite brick-size, but not far off) and we were never out of contact again – as long as there was a signal, of course.
These days virtually everyone has a mobile, so patients are instantly reachable, too. This has transformed telephone consulting: many discussions can be handled without someone having to trek to the surgery for an appointment, or to stay glued to their land-line waiting for the doctor’s call.
The signal is still frustratingly variable in our semi-rural area: conversations have a habit of hanging at crucial points and distortion can make it sound like I’m consulting with a Dalek.
One gets used to catching people at awkward moments. I’ve spoken to several who have confessed to being on the loo. And the more embarrassing the problem, the more likely it is that the patient will be in the midst of some social gathering: it can take ages for them to extricate themselves to ensure the necessary privacy.
Ultra-availability occasionally creates interesting scenarios. I recently had a message to ring Tina. Tina suffers from hypomania and if one happens to get her when unwell it can tie up a huge amount of time, so I was a bit apprehensive dialling her mobile number. Sure enough, she was very obviously high – I could scarcely get a word in as she regaled me with all sorts of disjointed and irrational experiences. I kept trying to find out where she actually was – she was clearly very unwell and was going to need assessment. Eventually, after listening to 25 minutes of hypomanic monologue, I managed to establish that I was ringing her in a psychiatric ward on the other side of the country where she had been detained under a Mental Health Act section. At least there was nothing I had to do.
Nowadays both doctors and patients can access huge amounts of medical information instantly. Apps remind people to take medication, send orders for repeat prescriptions, and can monitor vital signs such as heart rate and blood oxygen levels. The most impressive app I’ve so far encountered belongs to a Polish patient who speaks about three words of English: a voice-recognition, auto-transcribing Polish-English translation engine. We have conducted several consultations, handing his phone back and forth. It’s uncanny, watching it turn my speech into text – you can actually see it altering words between homophones as it reinterprets the context. At the touch of the screen, my English sentences are rendered in both audio and written Polish, and his vice versa.
The only glitch was when he tried to tell me that, at 67 years old, he’s started to have problems with his dad. I wasn’t surprised: his father was probably a nonagenarian. I tried to find out the nature of the difficulties; was it dementia, or advancing frailty? It took several puzzling exchanges before the penny dropped. “Dad” turns out to be an unfortunate mistranslation of a Polish euphemism for the male member. I’ve since been able to help the prostate problems that were making it increasingly difficult for him to pee.
The leap in technology in the space of a single generation has led to speculation that smartphones and apps will gradually displace doctors. I don’t doubt we’ll see further amazing advances, but medicine is an intensely human, interpersonal art. Technology will assist, but it won’t replace us. And, in any case, we would need to sort out the signal first.
Phil tweets as @pwhitakerwriter
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This article appears in the 10 Jan 2018 issue of the New Statesman, Toddler in chief