I looked down at my left leg. It had been aching for a day or two. Thanks to the laser eye surgery that I had had the previous month, I could see that the left calf was definitely more swollen than the right. I sat back in my chair and reminisced.
Back when I was a GP, in the early part of the 21st century, we would often be confronted with patients with swollen legs. The diagnosis that we worried about was deep vein thrombosis. I could even remember when it was called “economy class syndrome,” owing to one of the risk factors being the immobility and dehydration experienced on long haul flights.
These days, as I was retired, I spent more time being a patient than being a doctor. Except that with the advent of virtual general practice, I rarely saw a doctor in person. My NHS pension hadn’t quite been as generous as I had hoped, so I hadn’t opted for the Virtual Plus option of healthcare when face to face general practice was phased out in the 2050s. So, instead of getting a “virtual health cubicle” installed in my home, I had to travel to the local community health hub once I had logged in to the app on my watch-phone and relayed my symptoms to the central computer that held my records.
Of course, if my smartwatch picked up dangerous heart rhythms, a prolonged fever, or dangerously low (or high) blood pressure it would alert me, and send a message to my self-driving car to take me straight to the nearest hospital, where I could be assessed by robot physician technicians. My car’s autopilot function included a retractable blue light, siren, and chameleon paintwork that assumed the appearance of an ambulance when required; one of the perks of being a pensioner. I hadn’t opted for the primary implantable defibrillator for patients with no signs of cardiac disease.
“Swollen leg,” I whispered into my watch, knowing that I would then be asked a series of questions about risk factors for a clot. I wondered whether I should tell the truth or not, as I didn’t know if I could really be bothered to go through with all this. After all, 90 years old was not such a bad age, a bit below average for 2065 though.
“Please take a photo of your bare legs,” lilted the vaguely female voice. I obliged.
“The inbuilt pedometer calculates that your immobility index over the last few days has been slightly raised. Your photo would suggest that you have a unilateral leg swelling in excess of three cm. Your oxygen levels, heart rate, and respiration rate are acceptable. At this moment in time you may have a clot in your legs. This has not travelled to your lungs, yet. Please proceed to your nearest community hub for near patient testing. Your car is ready for you,” said the voice, in an insistent, but not quite commanding tone.
I hadn’t yet managed to alter the programme settings to convince it that I had 10 years of training and 30 years of experience as a GP. I suppose my knowledge was outdated now. I limped to my front door, which opened automatically after scanning my left retina. My car was right outside the door. I got into the back seat.
“Please do up your seatbelt Mr Dawlatly,” said the car.
“I’m a doctor. Was a doctor,” I answered as I clunked the belt into place. The car pulled away smoothly. I looked at my leg and swore at it, then tried to decide which of my children to tell if the blood test and subsequent automated ultrasound scan was positive for a clot. Perhaps the next of kin function would tell them automatically anyway.
I had no doubt, anyway, that it would be positive. Having helped design the protocol, I would also have to convince the central programme that I wasn’t suffering from dementia if I refused to have blood thinning treatment.
That was going to be the real test. I closed my eyes as the car seamlessly made its way through the rush hour traffic. How virtual healthcare had changed things.
Samir Dawlatly is a GP partner at Jiggins Lane Surgery in Birmingham. He combines clinical practice with being a part time house husband and an interest in social media, as well as publishing poems, essays, and blogs. He can be found on Twitter as @sdawlatly.
I have read and understood BMJ policy on declaration of interests and declare the following interests: I am a member of the RCGP online working group on overdiagnosis.