Remember the days before TikTok doctors and virtual consultations?

Columnist Dr Burnt Out reminisces about the good old days of general practice before patients were divided by their ability to navigate an increasingly digital healthcare system

The first of August 1981 was a big day in the history of popular culture. The first ever music video – Video Killed The Radio Star by The Buggles – was shown on MTV when it started airing in the US. It commented on revolutionary technological changes and expressed sadness that children of the time would not appreciate the way things were in the past.

Now, some GPs feel the same way about general practice, as the rise of remote consultations in recent years has changed the way we provide medical advice. They feel particularly sad that young GPs will never know the general practice of old, seeing it instead as a profession consisting of 12-hour days of staring at a screen, reading unintelligible online consultation queries, supervising ARRS staff, looking at blurred photos of body parts, firing off electronic prescriptions, and sending text messages – all while being constantly ‘on call’ for a high volume of emails. And that’s if the IT systems work (weeping face emoji).

Of course, telephone and email consultations can be suitable and helpful. But far too often we find ourselves stranded in a telephone, answerphone, poor-connectivity, please-call-back netherworld in which things can easily get missed and there is no satisfactory resolution to the consultation.

Whether it is safe and efficient to deal with lots of patients without actually setting eyes on them is still up for debate, and I believe that seeing patients in person is extremely important: not only in terms of giving correct diagnosis and treatment, but also showing that we GPs care. Many people also feel that they have not been properly assessed and treated unless they have seen a doctor in person.

Not to mention there are examples of cases where a coroner has stated that seeing a doctor face to face has likely saved the patient’s life. That’s why it is medicolegally prudent for GPs to write ‘declines F2F appointment’ where a patient does not want to come into the surgery and wishes to be seen remotely.

But for better or for worse, we cannot turn back time. Online consultations seem here to stay, and the fact that many GP surgeries in the UK have now turned into medical Mary Celestes is neither here nor there.

Increased digitisation over the past decade was supposed to increase the efficiency of primary care and the NHS as a whole, but judging by the current state of general practice, A&E and the health service, do we think this has been a success? What is the point of having online consultations when all they do is overburden already frazzled primary care teams with extra verbiage? What patients usually need is a direct-access face-to-face consultation or a brief phone call anyway.

The way patients from different generations respond to online consultations, however, is rather interesting – let’s take a look at how the seven generations interact with them.

The Greatest Generation (born 1901-1927)

Not many left unfortunately. Known for hard work, not moaning and grit. Unlikely to bother the GP with an online consultation, despite likely having high-care needs and undoubtedly nearing end of life.

The Silent Generation (born 1928–1945)

The youngest of this generation are now nearing 80. Many were born in the antecedent times and during the Second World War, which makes them often a hardy group. If they do send an online consultation, it will likely downplay their symptoms as they ‘don’t want to bother’ the doctor. 

Baby Boom Generation (born 1946–1964)

The youngest of these are nearly 60. There may be a few long silver haired ageing ex-hippies in this group who possibly may still be ravaged by the excesses of the 1960s and 1970s. Some of the men in this group are keen to get a prescription for Cialis. Generally, they should be okay with technology, so will be fairly regular online consultation users.

Generation X (born 1965–1980)

I must confess this is my generation. We were the first generation to be able to get home computers and many of us remember playing Space Invaders, Defender, Asteroids and Pac-Man at video arcades or other games on the first home computers. This means we should be fairly tech-savvy. We are, however, getting older and now travailed by the trials and tribulations of senescence. Quite often we think we might have cancer (and could be right). Or heart disease. Or early dementia. Still use X (*nee Twitter) and Meta (*nee Facebook) a lot.

This means we trouble the GP quite a lot. We also may have the pressures of ageing parents, unruly children, and marriage troubles. It is likely that we may be depressed and on sertraline 150mg daily (and wondering whether to increase the dose). 

Millennial Generation or Generation Y (born 1981–1996)

Okay, aged 28-42. Heavy users of online consultations. Often very busy at work and only able to have breathless conversations about potentially serious health problems between work meetings. They think the idea of taking a bit of time off work to see a doctor is faintly ridiculous. When contacted they have to spend a lot of time trying to find a ‘quiet room’ in the office so they can talk about intimate medical problems freely. They do not understand that doctors occasionally must examine patients in person and why they can’t just do it over text messages or something similar. Their social media of choice is LinkedIn, where they connect with health-tech entrepreneurs.

Generation Z or iGen (born 1997–2010)

Aged 14-27. Again, heavy online consultation users. In many ways they are charming, but some are consumed with anxiety problems, gender identity questions, and ADHD symptoms. This generation does seem to have many medical issues. They are very tech-savvy and would prefer if they could contact the doctor by Snapchat, WhatsApp or Instagram. They can be chronically anxious with bouts of depressive and ADHD-like symptoms. Sore throat of more than 15 minutes usually merits an online consultation.

Generation Alpha (born after 2010)

Aged 0-14.  Likely to have a mobile phone but parents (likely Generation X and Y) are likely to do the online consultation so may run along those lines. The older members of Generation Alpha get most of their health information from TikTok.

I do not want to indulge in too much nostalgia, but 1981 seems like a simpler and happier time.

Dr Burnt Out is a GP locum in London