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Internet Doctor


dmr

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End of last week I was not feeling at all well and by Saturday morning I was pretty sure I had got a nasty infection and could do with some antibiotics pretty quickly. My own doctor is 200 miles away and though they do a good "telephone consultation" service they have no out of hours cover. I could not find any local doctor open on a Saturday. I tried phoning the NHS 111 service but that really is next to useless, its just a call centre, they tried to put me in touch with the nearest NHS drop-in centre but messed up. The nearest drop-in that I could find was a 1.5 hour drive away. I really did not fancy a 3 hour round trip and a possible long wait.

Against all my lefty principles and dislike of private medicine I tried "Push Doctor" which is an internet based doctor service. This used a little app on a smartphone to provide a two way video link. There were a few technical issues but after a delay of an hour or so it was sorted, I talked to a doctor and an hour later a prescription was available at the local pharmacy.

It cost 20 quid for the consultation plus £8 for them to do the prescription. I also had to pay for the prescription at Boots because its private medicine (I sort off approve of this). They gave me a £20 voucher for future use because the technical issues were down to their server.

So, for liveaboard continuous cruisers this really is a very good service, its just sad that the NHS can't do something like this. Looking at the website it appears they use experienced GPs who are earning a bit of extra money working from home, mostly women as this is probably a good option for GPs with young children. 

................Dave 

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Personally I am more than a little concerned at a doctor prescribing antibiotics with out seeing you face to face and never having met you before.

Bacterial resistance to antibiotics is growing problem, much of it caused by Doctors prescribing antibiotics because a patient won't leave without them.

There is even a current TV add running trying to get people to not always ask for antibiotics and to take their doctors advice.

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1 hour ago, dmr said:

End of last week I was not feeling at all well and by Saturday morning I was pretty sure I had got a nasty infection and could do with some antibiotics pretty quickly. My own doctor is 200 miles away and though they do a good "telephone consultation" service they have no out of hours cover. I could not find any local doctor open on a Saturday. I tried phoning the NHS 111 service but that really is next to useless, its just a call centre, they tried to put me in touch with the nearest NHS drop-in centre but messed up. The nearest drop-in that I could find was a 1.5 hour drive away. I really did not fancy a 3 hour round trip and a possible long wait.

Against all my lefty principles and dislike of private medicine I tried "Push Doctor" which is an internet based doctor service. This used a little app on a smartphone to provide a two way video link. There were a few technical issues but after a delay of an hour or so it was sorted, I talked to a doctor and an hour later a prescription was available at the local pharmacy.

It cost 20 quid for the consultation plus £8 for them to do the prescription. I also had to pay for the prescription at Boots because its private medicine (I sort off approve of this). They gave me a £20 voucher for future use because the technical issues were down to their server.

So, for liveaboard continuous cruisers this really is a very good service, its just sad that the NHS can't do something like this. Looking at the website it appears they use experienced GPs who are earning a bit of extra money working from home, mostly women as this is probably a good option for GPs with young children. 

................Dave 

Exellent post and I shall find the thingy on line and save it on mi pooter in case needed on our wandering lifestyle. Funnily enough I have had bro in law onboard today he also lives onboard and travels and was asking me what I do about a dentist, funny old world innitt.

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28 minutes ago, Jerra said:

Personally I am more than a little concerned at a doctor prescribing antibiotics with out seeing you face to face and never having met you before.

Bacterial resistance to antibiotics is growing problem, much of it caused by Doctors prescribing antibiotics because a patient won't leave without them.

There is even a current TV add running trying to get people to not always ask for antibiotics and to take their doctors advice.

I have thought quite a bit about this. Over half of my visits to my GP are just a face to conversation with no physical examination, and because I don't go very often and there is quite a turn-around of staff I rarely see the same doctor twice, so this video link consultation did almost everything that a face to face consultation would have done but with much less effort (and I never like sitting in a waiting room full of sick people sneezing). If I had found a local GP or a drop-in centre they would never have seen me before either.

It would have been helpful if the internet doctor could have got instant on-line access to my medical records. I was advised to seek out a local GP in the next few days and told that this was absolutely essential if the condition recurs so this was clearly an addition to, rather than a replacement for, a traditional surgery.

Sadly the NHS trial that Jerra has found has to be taken as a full replacement to an existing GP.

..............Dave

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12 minutes ago, mrsmelly said:

Exellent post and I shall find the thingy on line and save it on mi pooter in case needed on our wandering lifestyle. Funnily enough I have had bro in law onboard today he also lives onboard and travels and was asking me what I do about a dentist, funny old world innitt.

Surely your Bro in law just needs to find an internet dentist?. I suppose that wouldn't work as well though because it would be hard to speak on the phone with yer mouth wide open :D

................Dave

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20 minutes ago, dmr said:

Surely your Bro in law just needs to find an internet dentist?. I suppose that wouldn't work as well though because it would be hard to speak on the phone with yer mouth wide open :D

................Dave

So one day we could have a little robot arm, complete with drill under the direction of an internet dentist.  I suppose if computers are smart enough to drive a car, then drilling and filling a tooth - so long as you keep still - would be easy.  Maybe this could become a new use for unused phone boxes in rural areas...........

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1 hour ago, Jerra said:

There is even a current TV add running trying to get people to not always ask for antibiotics and to take their doctors advice.

I find this advert quite annoying. I'd prefer them have a campaign aimed at the Doctors along the lines of the old "Just say no". The general public are not prescribing anti biotics for themselves - Doctors are prescribing them.

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7 minutes ago, Sea Dog said:

I find this advert quite annoying. I'd prefer them have a campaign aimed at the Doctors along the lines of the old "Just say no". The general public are not prescribing anti biotics for themselves - Doctors are prescribing them.

I too find it annoying but I gather from doctor friends that some doctors prescribe antibiotics as some patients would require physically removing if their request wasn't fulfilled.  As yet I don't know of a Doctors surgery that employs bouncers security (yes I know some hospitals and walk in centres do I am talking GPs)

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33 minutes ago, Jerra said:

I too find it annoying but I gather from doctor friends that some doctors prescribe antibiotics as some patients would require physically removing if their request wasn't fulfilled.  As yet I don't know of a Doctors surgery that employs bouncers security (yes I know some hospitals and walk in centres do I am talking GPs)

I would suggest prescribing something else which may get movement

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2 hours ago, Jerra said:

I too find it annoying but I gather from doctor friends that some doctors prescribe antibiotics as some patients would require physically removing if their request wasn't fulfilled.  As yet I don't know of a Doctors surgery that employs bouncers security (yes I know some hospitals and walk in centres do I am talking GPs)

Really? Crikey, what's wrong with these folk!? Maybe they should prescribe them tranquilisers or something to reduce their testosterone. Or refer them to a Swiss clinic.... :giggles:

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5 hours ago, dmr said:

Surely your Bro in law just needs to find an internet dentist?. I suppose that wouldn't work as well though because it would be hard to speak on the phone with yer mouth wide open :D

................Dave

 

I can see you're feeling better now. YAY!! :D

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7 hours ago, Jerra said:

Personally I am more than a little concerned at a doctor prescribing antibiotics with out seeing you face to face and never having met you before.

Bacterial resistance to antibiotics is growing problem, much of it caused by Doctors prescribing antibiotics because a patient won't leave without them.

There is even a current TV add running trying to get people to not always ask for antibiotics and to take their doctors advice.

Interesting isn't it. Antibiotic resistance is clearly something that is causing real concern, and having had many business conference calls find them a poor substitute for face to face meetings even with strangers. I am however not qualified to comment on how practical it is for a GP to form a suitable decision online.

If the online doctor has not made the prescription, would this thread be here. You then have an additonal conflict of interest to boot.

 

Daniel

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31 minutes ago, DHutch said:

Interesting isn't it. Antibiotic resistance is clearly something that is causing real concern, and having had many business conference calls find them a poor substitute for face to face meetings even with strangers. I am however not qualified to comment on how practical it is for a GP to form a suitable decision online.

If the online doctor has not made the prescription, would this thread be here. You then have an additonal conflict of interest to boot.

 

Daniel

I was an early (and unenthusiastic) user of video conferencing, and it was truly horrible. Also, like business phone calls, I find it a lot easier to talk to somebody who I have previously met in person. Times have changed and with smart phones video phone calls are now a part of everyday life. A consultation with a doctor is a pretty impersonal thing, its not like trying to build up a long term business relationship with a client, you just says whats wrong and they tell you how it might be fixed. 

..............Dave

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6 hours ago, Jerra said:

I too find it annoying but I gather from doctor friends that some doctors prescribe antibiotics as some patients would require physically removing if their request wasn't fulfilled.  As yet I don't know of a Doctors surgery that employs bouncers security (yes I know some hospitals and walk in centres do I am talking GPs)

I work in A&E as a consultant and also as a GP in Australia but prior to coming over here worked 15 years in the same roles in the NHS.  Yes - there are security in hospitals, not so much for those patients that get a tad annoyed at not getting their way (or what they expected) but for the take downs of very aggressive or sectioned patients.  The AB problem is even worse over here as we do not operate a designated GP system - you can go where you like.  So eventually a patient is going to find a doc would will give them what they want.  

Now as for seeing the patient, for the majority of incidences no this is not needed to determine if the infection is bacterial or viral as the site of the infection will give a clue.  Sure there are instances where there is doubt but this can only be resolved through culture growth and not by examination alone.  The main determinant is actually patient history and clinical gestalt.  I am not saying there isn't an over prescription of AB's at the moment but when you are faced with waiting list KPI's etc some less disciplined and certainly in my observation junior/defensive docs will cover bases by going down the AB route.

Unfortunately we live in a culture where the expectation is for a pill to instantly (or nearly) fix the problems.  Nature has developed its own defence - it's called a temperature, but all too often we take paracetamol etc to bring this down!!

I hope we don’t get to the stage of needing security in the GP surgeries as my experience is that if you treat patients with the expectation they are going to become misbehave, some will oblige when previously they wouldn’t.

(Wife of JJPHG)

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Two weeks ago the dog got very sick very quickly and was struggling to breath. It was Sunday and it was relatively easy to find a vet hospital was open (NHS take note :D).

The vet couldn't decide between a viral infection, a bacterial infection or even a swallowed object in the lungs. X rays and blood test results were not going to be available till the next day so an antibiotic injection was given in case it was a bacterial infection. I reckon that decision saved the dogs life.

In my case the internet doctor said that waiting till Monday for proper testing was the ideal approach, but felt there was a very good chance that the anti-biotic she was prescribing would work. I have no medical training but it does appear that a lot of medicine is a case of making some best guesses quite quickly.

Feeding anti-biotics to healthy farm animals is what needs to stop.

...........Dave

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7 hours ago, dmr said:

Feeding anti-biotics to healthy farm animals is what needs to stop.

...........Dave

In my experience there has been very little of that for quite some time now.

Having look things up there has been a downward trend over the last 10 years an antibiotics which are important to humans make up less than 1% of the antibiotics sold for animal use.

 

This means that any (well most) resistance to antibiotics in human infections is as a result of human use e.g. prescribing when it isn't vital or people not completing the course because they fell better.

Edited by Jerra
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I agree with the points about antibiotics not being the answer in every case. I am much more concerned that the push-doctor thingy, if the example is followed by the NHS, becomes yet another vehicle for private companies to make a profit out of the NHS, draining it of resources. Mr *unt can witter all he likes about the amount of money going into the NHS under his stewardship, but he is rarely asked how much of it is going straight out again in profits to the private sector.

Slippery slopes and back-door privatisation.

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21 minutes ago, Machpoint005 said:

I agree with the points about antibiotics not being the answer in every case. I am much more concerned that the push-doctor thingy, if the example is followed by the NHS, becomes yet another vehicle for private companies to make a profit out of the NHS, draining it of resources. Mr *unt can witter all he likes about the amount of money going into the NHS under his stewardship, but he is rarely asked how much of it is going straight out again in profits to the private sector.

Slippery slopes and back-door privatisation.

We all know the plan is to weaken the NHS so much that private medicine looks like the only realistic option and in my case this is exactly what happened and I am a huge advocate of the NHS. It was just not possible to find a NHS doctor on a Saturday within a reasonable distance so a private company was the only realistic option.

As is often the case with private medicine my private consultation was likely provided by a NHS doctor. It would be so good if the NHS could provide services like this rather than the useless 111 service (the NHS direct before it was much better). Sadly I am pretty sure that Mr *unt would prefer the NHS not to provide services that might be popular.

It will always be in the interest of a Tory government to run down public services to a point where private services are superior because this provides confirmation of their core ideology.

It was still a very good option for a liveaboard CCer though!

................Dave

forgot to add, I am just about to log on to my NHS doctors website (in Wiltshire) and by late afternoon a repeat prescription should be ready up here in Northwich.

Edited by dmr
added a bit more
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1 hour ago, Machpoint005 said:

Mr *unt can witter all he likes about the amount of money going into the NHS under his stewardship, but he is rarely asked how much of it is going straight out again in profits to the private sector.

The NHS pays the same rate for a treatment whether it's done 'in house' by an NHS doctor in an NHS hospital or one (possibly even the same one) in a private facility. If you wanted to set up a facility doing particular routine operations, say, you don't name your price - the NHS tells you the going rate and you have to find your profit by being more efficient at it. Some succeed, some don't. I don't have an interest (medical, political or ethical) on whether this is the best way to do things or not, so I have no wish to argue a case for it. :)

Edited by Sea Dog
Removed a surplus 'by' - perhaps that's a bypass operation?
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19 minutes ago, Sea Dog said:

the NHS tells you the going rate and you have to find your profit by being more efficient at it.

If there is a profit in it, there is a more efficient way to do it, so why not do it the efficient way and cut out the profit element altogether? The NHS is still paying for the administration and the infrastructure, so the profit is at least partly provided to the private sector because the NHS has already absorbed most of the costs. The more the "profitable" bits are flogged off, the worse it will get, because only the "unprofitable" bits will be left.

 

1 hour ago, dmr said:

We all know the plan is to weaken the NHS so much that private medicine looks like the only realistic option and in my case this is exactly what happened and I am a huge advocate of the NHS. It was just not possible to find a NHS doctor on a Saturday within a reasonable distance so a private company was the only realistic option.

 

I don't blame any individual for doing the best they can in their own particular circumstances, please don't take it personally!

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2 minutes ago, Machpoint005 said:

If there is a profit in it, there is a more efficient way to do it, so why not do it the efficient way and cut out the profit element altogether? The NHS is still paying for the administration and the infrastructure, so the profit is at least partly provided to the private sector because the NHS has already absorbed most of the costs. The more the "profitable" bits are flogged off, the worse it will get, because only the "unprofitable" bits will be left.

Well, I did say I had no wish to argue the case for or against it. That said, it is very frequently the same doctor doing the operation whether NHS or private.  Perhaps if those particular doctors spent all day with the NHS instead of devoting much of their time to private work...

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22 minutes ago, Sea Dog said:

Well, I did say I had no wish to argue the case for or against it. That said, it is very frequently the same doctor doing the operation whether NHS or private.  Perhaps if those particular doctors spent all day with the NHS instead of devoting much of their time to private work...

I know a guy that used to be a surgeon that worked full time for the NHS and half as many additional hours for a private hospital, he was paid far more for the private work than the NHS, that's why the doctors like private work and no government dare to stop them as the doctors union is the most powerful of all - but you don't see them at the TUC.

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1 hour ago, Machpoint005 said:

I don't blame any individual for doing the best they can in their own particular circumstances, please don't take it personally!

Its all very difficult and the boundaries are not clear cut. I did think hard and had some guilt before using the internet doctor, its the first time that I have used  private medicine. A couple of years ago my wife used a private dentist and regretted it, more expensive and poor quality compared to the NHS.

My heart is opposed to private medicine but my head can see quite a few advantages as long as the private sector provides additional services and does not aim to steal the more lucrative parts of the NHS. Trouble is there is always the "thin end of the wedge" syndrome. I purchased a service that the NHS could not offer at the time so don't feel too bad about it. I also accept that because of my chosen nomadic lifestyle I am making unusual demands upon an already stretched NHS system, though it usually copes well with this.

There are many other moral issues than I sometimes worry about. As a nomadic boater I have chosen to register with a lovely rural practice that provides a wonderful and efficient personal service. If I am in my home area I can usually get to see a doctor the same day if needed, certainly within a day or two. All of our children live in big towns and cities and get a pretty second rate service from their struggling GP system. If I had used a local doctor here I might have made it harder for a local person to get an urgent appointment. Maybe those with a bit more money should pay a bit more towards the NHS....but then an increase in income tax is the best way of doing that :D.

Its all politics! That snow in the peak district must be melting, the Dane and Weaver are both flowing, the levels are rising and a working boat (Eclipse?) just went up with its engine working pleasantly hard.....ooooh thats better.  

...............Dave

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