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The secretary is dead, long live the secretary

A consultant paediatrician complained to me that her Trust is ending secretarial support. Clinic letters will now be the responsibility of clinicians – which was poignant as she handed me one of the last letters transcribed by her secretary. It was a triumph for management, another penny-pinching scheme, another worker unemployed. 
 
People working in other industries will have little sympathy. Secretaries and personal assistants are more costly and less fashionable than a Google Calendar or a smartphone. Letters are novelty value, emails are common. The future of healthcare is imagined to promote wireless dialogue between doctor and patient. Less clinic time, more face time via a mobile application. 
 
Such direct access must make for a better world, cutting through the bureaucratic barriers that make it difficult for doctor and patient to end up in the same place at the same time. There's something appealing about pinging an email, or better a direct message on Twitter, to your heart specialist, poking your orthopaedic surgeon on Facebook, or instant messaging your general practitioner. 
 
Education icon, Ken Robinson, divides our existence into a world without us and a world with us. The future, he says, is about developing the world with us. The Internet and digital media offer a means to develop our world, and healthcare—like education—will be one of the sectors that will be transformed most dramatically. 
 
But the digital world has dangers. It is easy to be misinterpreted on email, to misread tone of voice and intent. There is no direct observation, the essence of a clinical art. Exchanges can be cold and unsatisfactory. Healing hands are of no benefit. Conversations can be rigid and unlikely to unravel the deeper issues that sometimes prompt a consultation. The soft skills of doctoring may be lost in a hardwired world. 
 
This is no Luddite plea for the old ways. Communications between patients and their clinicians must be encouraged. Yet, the inevitable consequence is that clinicians, already besieged by information overload in their attempts to stay up to date with clinical practice, will be battered further by communications overload in dealing with inquiries from patients. 
 
Doctors, you might think, should busy themselves with the work of doctoring, not grind themselves down with secretarial duties or sink under a tide of communications. Communication, of course, is a fundamental part of doctoring but managing those communications successfully in our future world will be a major challenge for health services. The medical secretary may not be dead just yet.