Takeaway tinctures

To the Editor: The coronavirus disease 2019 (COVID‐19) pandemic has changed the doctor–patient relationship. The technological revolution that is telehealth has brought undeniable benefits to patients, including greater access and convenience, and more control and empowerment through self‐care.1 There are high satisfaction ratings for patients utilising digital health care technologies.2 Unsurprisingly, there has been an increased uptake in the use of online prescription, referral and medical certificate services where a pre‐existing doctor–patient relationship is not always present.3

In our experience, there is an increasing digital incursion on the traditional general practice consultation. General practitioners are being pressured by their patients to issue prescriptions4 and referrals outside of scheduled consultations. Presumably to preserve the doctor–patient relationship and potentially business interests, we have seen GPs acquiesce to these patient requests, often with little to no consultation. This is occurring despite previous research showing that consumer demand is a driver of unnecessary tests and treatments.5 This non‐contemporaneous doctor–patient interaction exacerbates the demand for fast, convenient health care delivered how and when patients dictate. In this instance, ensuring consumer satisfaction is potentially at odds with ensuring good and safe patient outcomes.

There are risks of engaging with this type of instant medicine. Increased accessibility to, and demands made of, GPs increases their workload burden2 and precipitates cognitive overload. This emerging expectation of doctors to engage in asynchronous interactions with patients, outside of consultations, creates what we term a “digital fourth wall”. Patients can access their GP in an inherently one‐sided encounter, with doctors given little time and opportunity to reciprocate. Our concern is that the impersonal nature of this doctor–patient interaction may beget a diminution of professional responsibility towards the patient and suboptimal treatment and diagnosis.

Striving for a mutually acceptable outcome through shared decision‐making processes will ensure that duty of care to the patient, based on GPs’ best clinical judgment, is not compromised. This may mean saying “no” to a patient, despite what we observe to be the natural inclination of many GP colleagues to acquiesce to increasing digital demands. The medico‐legal risk, and responsibility for patient care, ultimately rests with the GP. Despite appearances, novel innovations in technology do not always lead to health improvements.