Nightmare in 2020:
a day in the life of Dr Zen, FRACGP

A tired-looking woman is sitting in the medical service bay at Corporation Enterprise (its motto: "Live long and prosper"). The electronic doors open to admit an overweight man. He faces her across a waist-high console. She scans his online medical record with her level 5 clearance. "Mr Unger, you have a five-minute consultation today. How can we help?"

"I don't feel well —."

"Chest pain?"

"No, just not feeling myself. Since my wife died. My complementary practitioner can't help me. Can you?"

"I'll try", Dr Zen replies. She selects the "Social stressor" option on screen. "Which of these symptoms do you have?"

She reels off a list. He replies. They work their way through the appropriate algorithm pathway.

"So, according to our evidence-based, Glerck-Pficham-sponsored guidelines, you have type III depression."

A silent alert flashes on the screen: "Time's up!"

"I'll prescribe you Ease, which [reading from the screen] has been effective in 360 hospital patients. You're also entitled to three telesessions with our cognitive behavioural therapist courtesy of Ease." The manufacturer of Ease has a Memorandum of Understanding with Corporation Enterprise.

Dr Zen issues the script and patient education printout. Mr Unger walks out the door, triggering another screen message: "Consultation was two minutes over time — third infringement today. Action 1: repeat practice management module during your Quality and Education session."

Dr Zen sighs. She had wanted to try the clinical research module instead. No wonder GP research in the Med e-J of Australasia is so dull: only non-clinicians and corporate administroids have time for it. But who wants to know about health service models and cost analyses?

"Action 2: 5% deduction from today's pay for time infringements." Yeah, well what about patient care instead of the bottom line for a change? She makes an e-note to mention it again at the next corporation meeting with the Managers. Mustn't put them offside though. They may be heavy-handed but they're the ones doing the real work in general practice — administering new government health initiatives that appear monthly.

Dr Zen is indentured to serve in this busy outer urban centre for another two years. Her husband is rural, but telemedicine clinics are making rural work easier these days. Like most doctors, he'd been put off becoming a GP by his compulsory term in "area-of-need" general practice. But beggars who miss out on other training schemes can't be choosers ...

After her corporate session, Dr Zen drops in on the nurse-practitioner clinic in the slums to see medical referrals from the nurse. This government got in on the promise of "Primary care for the public". But the post-election reality: a teary 72-year-old whose Work-For-the-Aged benefits have been restricted as she can't afford a computer and missed the e-reminder for her Well-70s check.

Dr Zen can't wait to do her taxi shift this evening. Thank goodness for time to talk to customers. It'll keep her going in more ways than one.

Ann Gregory and Mabel Chew
Deputy Editors, MJA