On a Tuesday afternoon every week the medical team at Hoy and Walls Health centre convene in a quiet room, positioned around a large television screen. What comes next does not involve popcorn or the latest blockbuster but a video conference meeting of GPs and nurse practitioners from the islands of Hoy, Westray, Stronsay, Sanday, Rousay, Papay Westray, Eday, North Ronaldsay and Flotta. Practices on these islands make up the Isles network of care; established in 2010 by NHS Orkney to promote shared experience and support between health care workers practising on the islands.
In previous blogs I've touched on the absolute autonomy experienced by Iain and other island GPs and nurse practitioners when making decisions and the feeling of isolation that can occur as a result. Other than the support perhaps of a practice nurse, as is the case on Hoy, they work alone. This requires a certain level of confidence in not only dealing with medical situations but a variety of scenarios that are cast in their direction due to the predominant lack of police and other services on the islands. It would not be unusual for Iain to be called to investigate a missing person or an over turned car. He is not simply the only doctor on the island, he is also the only professional figure of authority, a role yet further increasing the potential burden and feeling of responsibility.
The subject of 'burnout' amongst GPs has, for a long time, been a hot topic. There is an ever-increasing recognition of the intense and overwhelming nature of the job with numerous support groups now available for doctors, enhanced media interest and an effort to involve strategies for avoiding the problem and increasing wellbeing in medical training ( I can even recall being asked what I do to relax in a medical school interview).
Amongst professional bodies and between colleagues, we now talk of coping with the pressures in terms of building resilience. The word, and idea it represents, is everywhere. It's something I've thought a lot about since coming to Hoy. The stories of challenging cases handled alone and the concept of a continuous 'on-call' have provoked, in me, many thoughts of, 'How does the doctor here not get worn down?' , 'how do they look after themselves?' and 'is it possible to 'switch off' from the decisions they've made?'. The answers to some of these questions seem very much to lie in the support gained through these weekly meetings.
I was dubious, before taking part in the video conference, about how effective meeting via a screen could be. There is something, however, about seeing peoples' faces, digitally or otherwise which engages you more than a telephone call. I was surprised at how natural and fluid it felt, aided by a strict system of allowing each person to speak uninterrupted! The meeting starts with that week's hospital admissions being discussed, allowing time for the referring doctor to explain and consider their decision and for others to offer their thoughts. Hearing the accounts from people themselves made the cases personal and I was particularly impressed at how much time was spent reflecting on how difficult events had affected the professional involved. Cases from meetings where this was very notable included a tragic drowning incident on one of the islands and a demanding and stressful palliative case on another. Listening to the experiences made me reflect on the importance of this weekly gathering; not only did it seem to go some way to easing the isolation inevitably felt by island medics but also provided a space to talk about some of the challenges unique to these populations, such as having to treat people you considered your friends, with people who genuinely understood and could empathise. The geography of the island system would make meeting in person regularly impossible. New and improving technology allows this to happen.
As well as proving vital in supporting the wellbeing of the healthcare workers on the islands, I have observed during my time here how technology has radically changed the face of access to secondary care on the island. As I've mentioned before, attending a hospital outpatient appointment from Hoy usually means three bus rides, a ferry and a flight to Aberdeen, as well as an overnight stat depending on the weather! This comes at great cost (Orkney is one of the most expensive areas in terms of NHS funding) but also great inconvenience and, at times, distress to patients. Take a moment to imagine, for example, that you are elderly and live alone. You have not left the island or perhaps even your home for many months. You become unwell, are feeling more vulnerable than ever, and are told you need to make the 250 mile journey to see a specialist for 20 minutes. This scenario is not uncommon and the community, very familiar with the challenges of the environment they live in, will rally around making sure people are taken to the ferry and often even accompanied the whole way to appointments. It is still not ideal, however, and therefore the introduction of video conferencing with secondary care specialists has been very warmly received. This is now commonplace for specialties such as oncology where patients benefit from regular support but perhaps do not need physical examination every time. The system allows a patient, on average, more time as well as the potential for their GP to sit in on the appointment providing better continuity of care.
There are, of course, limitations to a process that does not involve meeting someone in person but for the most part it plugs a hole and, as above, is making it easier for people to live and live well in a challenging environment. In the past week I was involved in the case of a young patient suffering with alcohol dependence and severe depression; through the use of video conferencing she was able to see a psychiatrist within ten days. I think my London colleagues would agree that makes for an interesting comparison...
The successful use of technology here has made me reflect on my own practice and whether there would be greater room for its use elsewhere, but is there a downside? Find out soon in the next installment..