Over four hours of phone consultations a day: how GPs now work

Sant Boi de LlobregatTo get to Dr Daniel Moll's office at the Vinyets Primary Care Center in Sant Boi de Llobregat, you go up to the second floor and pass through three waiting rooms. In the first room there are a lot of chairs, one next to the other, all well arranged. Some of them even tape across the back of the seat to ensure social distancing. Everything seems perfectly prepared to receive patients, but there are none. The room is completely empty.

In the second waiting room the same picture is repeated: there is not a single soul. And in the third, a single person is waiting patiently for their appointment. "It was not like this before. All the waiting rooms were full and some people were even waiting standing in the corridor," explains Dr Rosa Saladich, who is a GP at the same centre. Everything changed, however, with the pandemic.

The director of CatSalut, Adrià Comella, corroborated last November 18 that the coronavirus has indeed changed primary care: 57% of consultations in the health centres are now telematic and only 43% are face-to-face, he said. He added that this is the way forward for the future, pandemic or not. To this end, the health department plans to distribute 8,000 webcams, 3,000 laptops and five hundred phones to primary care centers.

Dr. Moll has a video call consultation with a patient at 9:30 a.m., but it's almost 9:40 a.m. and the woman has not yet connected to the CatSalut platform. "That's strange, I'm going to call her on the phone to clarify what's going on," says the doctor. "Hi, I'm Dr. Moll. Are you having trouble connecting? Well, in theory it's easy, you just have to click on the link I sent you," the doctor explains to the patient over the phone. "Yes, yes, you have to activate the camera and the microphone on your mobile," he continues, but there is no way. The woman says that it's all a muddle and that her son, who could help her, is at school and will not be back until noon.

Dr Moll, resigned, tries another patient but encounters the same problem: the woman does not know how to connect to the CatSalut platform either. "I don't understand it, they are patients who are about 45 years old," says the doctor, implying that in theory they are people who are familiar with new technologies. And the system seems easy: Dr Saladich does a test with her own mobile phone and manages to connect at first. "It's also true that people are immediately overwhelmed by the whole technology issue," says the doctor. Ideally, we should use WhatsApp, because everyone knows how it works, but we can't use it because of data confidentiality issues.

In fact, Dr Moll has just confessed that on June 4th he made a video call consultation through the CatSalut platform and has not made any more. It was his first and last. However, he says, it is true that now more than half of the consultations are non-presential - as the director of CatSalut stated - but they are made by telephone. "We do about four and a half hours of telephone consultations a day, and one and a half hours of face-to-face consultations," he says. For this, they use old-fashioned landline phones, with a headset and no possibility of talking hands-free. CatSalut's platform may be very modern, but the computers and telephones in the offices do not seem to be latest generation.

"I use my personal mobile phone a lot because my hand gets tired from holding the handset for so long," acknowledges Dr. Saladich. She says she has learnt to call with a hidden number, although this is sometimes counterproductive: "Many patients don't answer when they see that I'm calling them from a hidden number or their phone rejects the call directly".

Dr Moll finally visits a patient, but this time on the phone. He tells her the results of a test, what medication she needs to take, and the appointment for two months from now. The consultation takes only a few minutes: quick, easy and effective. "There are really visits that can be solved over the phone," says the doctor. Yet, he admits, there's nothing like seeing the patient face to face.