From the consulting room on how IT and GPs are the same, but different

An IT technician’s visit has regular columnist Neil Paul pondering the many similarities between their profession and his own. Perhaps it’s time to talk tactics?  

I’ve had a revelation – well revelation is maybe too strong; maybe realisation is better. IT services and general practice seem to have a huge resonance with each other and perhaps we can learn from each other as well.
At one end of the spectrum, we both deal with clients who have their own needs and wants. Yet, at the same time, we have to implement national policy that - while usually well meaning - is often inconsistent, driven by politics or other people’s agendas, and struggling to keep up to date with the latest research and trends.

We both have to do a lot of things just to allow others to monitor us, which don’t really help us to get on with our work. And we both do a lot of routine, humdrum, bread and butter stuff that needs to be done, yet isn’t glamorous, well resourced or even appreciated.

Both professions have made huge changes in the past 20 years that have influenced and changed numerous lives with little explicit acknowledgement. Did you know that treatment of blood pressure in general practice is the main reason for falling stroke rates and that this trend has nothing to do with hospital care?

Meanwhile, our clients vary widely in their knowledge and understanding of the subject and are usually selfish in that they see their problems as the most important thing to be dealt with. They also vary immensely in their willingness to take part in the process, with some wanting it all fixed for them and some wanting to do all the fixing themselves.

At the same time, our professional colleagues have a wide range of skills and experience and interests, with some constantly pushing the boundaries and innovating and some mountains waiting to be moved by teaspoon. I could go on, but there is enough here to make the point.

The invisible man in the van

This all dawned on me when a new technician visited the practice to sort out a printer. We had duly logged the problem. The technician turned up in record time and came and went unobtrusively.

Unfortunately, he was so stealth-like that nobody knew he had been, or that he had only got the printer working with one of the two PCs that needed it.

This was a simple problem, easily sorted, and isn’t meant as a dig at our IT department. On the whole, they do a great job. Indeed, having spoken to GPs in other parts of the country, I am going praise them at every opportunity.

However, one of our administrators complained loudly about what they saw as an example of poor service. I had just been talking to one of our GP registrars about a patient who was complaining of the same thing.

We had discussed how poor communication was the cause of most complaints and how different models of consultation might address this. The printer problem, I pointed out, raised many of the same issues.

Models of communication

In the 1980s and 1990, the Royal College of GPs went through a phase of promoting the consultation above all else. It raised good communication skills to be the foremost attribute of a GP.

It developed numerous models of what goes on in a consultation, using language such as the doctor’s agenda, the patient’s agenda and hidden agendas. It even tried to ground some of this in Berne’s model of transactional analysis.
Doctors are now taught to look beyond the medical model of history, examination and investigations and to seek patient’s ideas, concerns and expectations. One of the famous systems by R Neighbour talked of Connecting, Summarising, Handing Over, Safety Netting and Housekeeping.

I wondered how much of the consultation skills approach was applicable to the visit by the IT technician. What was his agenda? What was ours? Were we both happy at the end? Could the technician have profited by an understanding of consultation models? Could IT services as a whole benefit from some of this kind of work?

Now it may be that the equivalent of consultation models exist in the IT world and every other service-type profession, but go by different names, depending on whose theoretical models were used to develop them. 

If so, forgive me for pointing out the obvious – but let me turn things around and ask what general practice can learn from the IT world about dealing with different masters, having conflicting priorities, limited time and resources and an ever expanding workload? Given the similarities between us, it is surely time for us to talk more and share strategy?