Dr Hennessey is advising Dave, a student with asthma. It's clear that his asthma is not under control, and he needs to be switched to a different inhaler. Dr Hennessey writes Dave a prescription, gives him a link to an online video showing how to use an inhaler properly, and tells him to let her know if he has any issues in future. Dave thanks her and gets the new inhaler the next day.
Dr Hennessey lives in London. Dave lives in Newcastle. They've never met.
Dave's entire consultation was conducted over the internet and telephone. His inhaler was sent through the post.
Dr Hennessey does dozens of these types of appointments every day. I know this because she sits next to me. At DrThom, we've been managing patients remotely since 2002 - over 500,000 so far.
Last week Health Minister Dan Poulter launched a health report called Digital First, which purported to advise the NHS on how to do remote healthcare.
Had they asked us for advice, we would have been happy to give it. Chiefly, we would have told them to stop getting distracted by Skype.
GP consultations over Skype are the part of the report that's captured the headlines. I'm sure this is highly irritating for the authors, since Skype is not actually a major feature of the report. But the Daily Mail's headline was "GP visits to be replaced by Skype consultations in bid to save NHS £3bn", the Telegraph's was "Doctors could Skype patients to save time and money", and at the weekend doctors took to Twitter in droves to discuss the idea of seeing patients over Skype. (Mostly they hated it, although some psychiatrists pointed out they already use it with patients desperate to avoid the GP waiting room.)
Unfortunately, Skype is simply a huge distraction when it comes to mass remote healthcare, especially when coupled with huge headline cost savings.
GPs' ability to make a diagnosis based on unspoken communication, body language and examination is already one of the best 'money savers' our NHS could have. There's no evidence Skype would make this process any faster or cheaper. There's no way it's going to save the NHS three billion pounds (and the report didn't say it would). Demand from patients for our Skype-a-doctor service has remained very low - we do only one or two a week, compared to many hundreds of telephone and internet consultations.
In the example above, Skype wouldn't have added anything to Dave's consultation, and might have made it take longer.
But that doesn't mean that there's no opportunity to shift care online. Luckily, Skype is not the beginning and end of the internet's capabilities. And I do hope that the distraction of Skype hasn't poisoned the atmosphere against the huge benefits that online healthcare could offer the NHS.
If you already have a diagnosis, and what you really need is ongoing management, education and reminders, this can often be done just as effectively online--and much more quickly.
Instead of using Skype, our patients give their patient history online, using carefully-designed forms. They can do this any time that suits them, day or night. When our doctors are ready to look at the form, the online patient management system then presents clinically-significant answers. If need be, the doctor can send the patient a secure message or telephone them. This way, Dr Hennessey is able to treat many more patients in an hour than during her normal NHS clinics.
Of course, there are plenty of patients that it wouldn't be appropriate to treat in this way. More often than not in normal general practice, patients do need a physical examination. And you will always need the option of face to face for patients who don't have access to the internet, or who just prefer to see their GP in person.
But for the patients that want to use remote healthcare, the ones who don't need a physical examination, the ones who don't like waiting for an hour in a GP surgery for a ten minute conversation, there's no reason not to roll out this system across the NHS.
The Skype distraction aside, it's encouraging to see the Health Minister recognising that not every GP consultation has to involve the patient physically turning up in the GP's surgery. It's encouraging to have someone at the top re-affirm that internet medicine is credible, and even preferable for many patients. While it's obvious to those of us that work in it every day, it's a big step forward for the Department of Health to promote the idea.
The Digital First report went so far as to say that a third of all GP appointments might not need to be physical. One-third of appointments delivered remotely is a huge aspiration, requiring more sophisticated systems than even the best remote primary care providers have at the moment. But as long as we can retain the principle that anyone who prefers a face to face appointment can have one, and that all of this should be driven by the needs of the patient, it's an exciting aspiration to work towards.