Beat the NHS backlog ...diagnose yourself

PATIENTS will be allowed to bypass their GP and refer themselves for hospital treatment as part of a radical patient "DIY diagnosis" plan being considered by the Scottish Executive.

The fast-track scheme would enable patients who have used the internet or medical books to diagnose their illnesses to see a consultant without the need for an appointment at their local surgery.

The plan, proposed by a senior Glasgow consultant, has won the backing of the British Medical Association and the Royal College of Physicians of Glasgow and is being investigated by the Scottish Executive.

John Sinclair, a urologist at the Southern General Hospital in Glasgow, said abolishing GPs’ traditional role as ‘gatekeepers’ to the NHS would reduce pressures on family doctors and cut hospital waiting lists.

He said patients now have such ready access to detailed medical information that many can accurately determine what is wrong with them and choose which specialist they should see.

Sinclair, 60, who has been a consultant for almost 30 years, said: "I know this is a very radical proposal and would require a great deal of consultation with GPs, hospital staff and patient groups. But we need to start making radical and innovative changes to the health service if it is to survive."

To prevent consultants being overrun with hypochondriacs, Sinclair proposes the creation of ‘diagnostic units’ staffed by specialist nurses or appropriately trained GPs who would carry out an initial assessment - a job normally carried out by specialists.

In some cases, a referral might not be necessary. The units would relieve pressure on specialists, giving them more time to perform surgery or other frontline procedures and hence reducing waiting lists.

Sinclair said: "The idea is to have mobile diagnostic units instead of fixed clinics, thereby extending the service over a wider area and meeting demand where and when it arises.

He added: " Non-urgent patients are waiting an average of six months to see specialists after being referred by their GP. I am seeing twice the recommended number of patients each week.

"There will be some inappropriate self-referrals , but I am convinced the advantages would far outweigh the disadvantages."

Sinclair claimed that strict professional auditing of the service would ensure that the standard of diagnoses was maintained.

David Smith, vice-president (surgery) of the Royal College of Surgeons and Physicians of Glasgow, said: "In principle we believe there is a lot of merit in this scheme. So long as it did not put further pressure on staffing levels within the NHS and the diagnostic units were manned by new specialist staff, this could do a great deal to fast-track the system to the benefit of staff and patients."

A spokeswoman for the BMA Scotland said the proposal had much to commend it, but warned: " While some services may adapt easily to this type of environment, others require to be provided in a clinical setting."

A spokeswoman for the Scottish Executive said the scheme would be considered as part of the process to improve patient care. "While not all suggestions prove workable, we welcome ideas on ways to further improve access to health services."

Doctor on the web: top 10 health sites

www.nhsdirect.nhs.uk

The companion site to the NHS’s 24-hour-call-line, NHS Direct Online offers health information and advice. Featuring a self-help guide and medical encyclopaedia, visitors can diagnose their ailments via an interactive medium. If the information desired is not on the site, e-mail requests are accepted and replied to by health professionals.

www.medicdirect.co.uk

This privately-owned website is hosted by 26 NHS specialists and offers more than just self-diagnosis tools. A comprehensive library of video-recorded operations are available for viewing and an ‘Ask the Specialist’ section allows visitors to post questions. Like NHSdirect, this site provides an advice phone-line, but at 1.50 a minute.

www.WebMd.com

WebMd remains the internet’s most successful medical information site. Boasting ‘Health-E-tools’, visitors can assess health risks based on family history or track their health with a Diet & Fitness Journal. Animated medical guides discuss and illustrate common ailments while daily ‘live’ events allow visitors to interact with doctors in real time.

www.Mytherapy.com

For those more concerned with psychiatric disorders, Mytherapy is a mental well-being site. For a subscription fee, users gain access to treatment information and research on 54 of the most common mental diseases. Online diagnosis of other disorders is also available. Having chosen a suspected illness, subscribers are taken through a series of multiple choice questions which, once answered, result in a yes or no diagnosis.

www.medical-library.org

Designed for doctors and patients, medical-library requires an annual subscription fee. Online diagnosis is available, along with a complete medical textbook and journal library.

www.easydiagnosis.com

Backing the high-tech interactions found on most popular medical websites, Easydiagnosis focuses purely on self-diagnosis. For a user fee, visitors can search through broad symptom categories to uncover their ailment.

www.patient.co.uk

Patient.co.uk serves as a jump-station for UK-based health information. Links to everything from patient-support groups to NHS sites. Like Medicdirect, a GP-manned advice phone-line is available for 1.50 a minute.

www.netdoctor.co.uk

Touting itself as "the UK’s independent health website", Netdoctor hosts a number of discussion communities covering topics such as depression and smoking. Self-tests also tell visitors if they suffer from a negative body image or an unbalanced diet. Again, a 1.50 a minute phone-line allows users to speak directly with a General Medical Council registered doctor.

www.ecureme.com

E Cure Me offers live consultations with a doctor or life-style consultant via the internet. Its self-diagnostic centre lets surfers enter their most troublesome symptom, and a quick search reveals possible illnesses and treatment.

www.omni.ac.uk

For those who don’t know where to start, Omni provides a searchbase for UK medical help and treatment. Its database provides lists of websites dealing specifically with user queries.