What is a doctor? If you visualize a GP, what do you see in your mind’s eye?
For many of us, the stereotypes learned in childhood never really fade. I am a thirty-something female GP myself, but I admit that my mental image of a doctor consists of a solemn, grey-haired, bespectacled man in a tweed suit. Unsurprisingly, my own childhood GP actually looked very much like that. He always seemed ancient to me, though when I do the math, he was probably only in his 40s at the time.
I remember being truly terrified by the life-sized skeleton looming in the corner of his surgery, the eeriness of which was partially offset by a giant Mickey Mouse soft toy that sat on his desk. I also distinctly recall the dread of having “ that stick thing” poked down my throat. (These days, when I examine a clamp-jawed kid with my tongue depressor, I can quickly find my empathy when I remind myself of my own childhood terror).
I remember watching the urine dipstick standing in a pot of wee, turning all the colors of the rainbow, and marveling at how this clever man could figure out all these tricky things and make me well again. And he always seemed to be close at hand whenever anyone in my family was unwell- rain, hail or shine, he’d arrive at our house in his beat up old car, often at an ungodly hour-and when his work was done he’d head off into the night, undoubtedly to visit some other sick person in the village. No wonder he looked ancient!
The next doctors to enter my consciousness were fictional, and came via the TV screen. There was “Dr Quinn Medicine Woman” ( a.k.a actress Jane Seymour), with her artfully disheveled hair braided over her shoulder, who trundled along dusty roads in her horse and cart, visiting the sick folk of Colorado Springs. (Only much later did I discover that she had previously been a Bond Girl- a fact that shocked and impressed me, in equal measure).
Funnily enough, the Aussie soap “ A Country Practice “ was broadcast in Ireland, back in the day, and we watched it religiously in our house through the late 80s and early 90s. Dr. Terence Elliot was the composite doctor- steady, dependable and wise. Admittedly, the people of Wandin Valley seemed to suffer rather more than their fair share of disease and calamity, but fortunately for them, Dr. Elliot was always there to pick up the pieces.
Then there were the venerable family physicians in various Jane Austen period dramas. The heroine usually had a broken heart which rapidly ( and inexplicably) progressed to a life-threatening illness. The doctor would arrive in his barouche, and dutifully bleed his patient to rid her of disease. The feverish girl would just about pull through, and invariably bag her Mr Bingham or Colonel Brandon shortly afterwards.
Whilst these various doctors of my childhood- both real and fictional- are seemingly quite different from each other, they do share certain traits. One such trait is the prominent place of the house call in their work. The house call was a traditional aspect of medicine for hundreds of years but it has largely died out in modern general practice. Aside from palliative, frail or bedbound patients, people are expected to make the journey to see the doctor and not the other way around.
There are many practical reasons for this change- the main one being that a doctor driving around the countryside can see far fewer patients than a doctor based in the surgery. In a society where there are not enough doctors to go round, it makes sense to keep the doctor in the clinic seeing as many sick people as possible.
There are some drawbacks to the loss of the age-old house call tradition – often, when we are sick, the last thing we want to do is sit on a hard seat for a long time in a heaving doctor’s surgery, among other unwell people. And there has perhaps been a loss of that very personal and human connection formed when a doctor comes to see you on your own ground, and on your own terms.
Personally, whilst house calls were very time-consuming and often took up an entire lunch break when I worked as a GP back in Ireland, I was always interested in meeting a person on their own turf- it often revealed the true context of a person’s life- and sometimes revealed stories that were harder to uncover in the setting of a busy clinic. (I’ll never forget the lady with a long term unexplained chronic cough- after months of puzzlement on my part, a house call for an entirely unrelated issue allowed me to discover that she shared a very dusty bedroom with a flock of guinea pigs and rabbits!)
However, in a slightly different format, the house call may be set to make something of a comeback. The concept of an “online doctor” has been emerging over recent years, and with ongoing advances in IT, it is now often possible for a doctor to assess a patient and conduct a thorough history online. Examination may not be possible as yet (though with advances in technology, it is probably only a matter of time before there will be a way to examine a patient remotely). And most GPs will attest that many common conditions seen on a daily basis are treatable on the basis of a conversation, without a need for examination.
Dr Sicknote is a new online doctor service of this nature, which offers an array of medical services on line –including re-referral letters to specialists and medical certificates for certain illnesses. Over the coming months Dr Sicknote will also offer treatment for a variety of medical conditions and where appropriate, it will be possible to obtain repeat prescriptions, such as the contraceptive pill.
The advent of the “online doctor” may in some ways bring us full circle: once again, a doctor will visit patients in the comfort of their own home- offering that personal connection, on their own turf and at their own convenience – though maybe this time without the tweed suit and spectacles!