The doctor will see you now… on your smartphone

One Friday afternoon, I decided to check out a pea-sized lump on my neck that was causing me consternation. I started by calling my GP’s surgery in south London. A recorded message informed me there were no appointments that day; after a few minutes, a receptionist came on the line and said that I could have an appointment on Monday. Not too bad, I thought, until I realised she was not talking about the Monday three days hence, but the one 10 days away. Not so good. I could also try for a walk-in slot or a phone consultation from 8am to 10am on weekday mornings.

At this point, I downloaded the app from Babylon Health, one of the leaders in online doctor consultations, on to my smartphone. The homepage was purple and teal, the writing welcomingly blobby. I tapped on “check a symptom” and after half-a-dozen questions, it suggested that I “book a consultation”. I was offered a choice between a GP, a specialist or a therapist. The appointment could be on the phone or a video call.

I selected a GP and a video call and was booked in to see Dr Patel 34 minutes later. As I waited to speak to him, I learned from his biographical detail that he was practising in Leeds, that he’d visited five of the seven continents and enjoyed cycling and skiing. At exactly 3.30pm, he materialised on my phone and welcomed me to Babylon. Our appointment was much like a regular exchange with a GP. There were some surreal moments: as I tried to show Dr Patel my neck, I was reminded of an Amy Schumer comedy sketch on the precariousness and indignity of sexting.

But he was engaged and reassuring, calling back when the video feed dropped, and after a few prompts he determined we were probably looking at a sebaceous cyst. They are non-cancerous and can be left alone, as long as they don’t change in size or shape. Soon after the consultation, in case I’d forgotten anything, a video of it was available on my Babylon app and I was sent a short text from Dr Patel that summarised his findings and advice. If I had needed a prescription, it would have been sent within the hour to a local pharmacy. Two days later, my phone beeped with a message to check how I was feeling.

It was a very thorough service, but there was a cost. Babylon offers its triage services, which advise on the urgency of treatment, free, but to speak to a doctor, it’s a rolling monthly payment of £4.99 or a one-off fee of £25. In my case, it provided peace of mind 10 days quicker than if I’d waited to see my GP. But the bigger question is what impact online doctors will have on the provision of healthcare in the UK: are they a valuable tool to reduce the demands on our overloaded doctors and nurses or are they, as one GP I spoke to said, opening “a door to NHS destruction”?

The offices of Babylon in South Kensington have been designed to evoke the hanging gardens, one of the seven wonders of the ancient world. A tough brief, you’d imagine, and the original designers estimated a cost of £1,000 per square foot. Ali Parsa, the founder of Babylon, bristled at such extravagance and decided to oversee the decorations himself. The result is a long, open-plan office with fake trees and hanging plants dotted around. All the accoutrements of the kidult, forward-thinking workplace are present: free toast and cereals, ping-pong tables that double as large desks for team meetings. An adult scooter leans against a desk, although it’s not clear if this is personal transportation or to whizz along the banks of desks.

Why the name Babylon? “First, I was born in Iran,” says Parsa, an energetic, fast-talking 51-year-old with a bald head and statement Cutler & Gross spectacles, “so Babylon was always part of our culture as one of the big Persian cities. And two, there is a story about Babylon that goes really well with healthcare. If you got sick in Babylon about two and a half thousand years ago, you’d stand on the square that was designated as a square of the sick and every resident that passed by would tell you if they’d ever come across that disease and, if they had, how they cured themselves. And with that very simple peer-to-peer health service, they had the longest life expectancy in the world.”

We are going to put an affordable health service into the hands of every person on Earth

Babylon’s mission statement

Parsa laughs: “But the truth is that all of that is nonsense. We called it Babylon because we were too cheap to pay a design agency or a PR agency to go out and figure out some funky name.”

In the reception area, the mission statement of Babylon is written on a large mirror: “Our purpose is to democratise healthcare. We are going to put an accessible and affordable health service into the hands of every person on Earth.” That’s quite an ambitious goal, I suggest.

“Of course it’s difficult,” he nods. “But actually, if you dissect that, the most difficult part is that you put something in the hands of every human being on Earth. Well, somebody already has. Almost every human being on Earth now has a mobile device. What Elon Musk is doing with SpaceX, creating a ship, sending it to space, that’s difficult! Putting a doctor on your mobile phone, relatively speaking, is not difficult.”

A number of progressive tech entrepreneurs appear to agree with Parsa. Push Doctor, founded by Eren Ozagir, claims to be the largest service of its kind in Europe, with about 7,000 NHS doctors in its network. It came about, apparently, after Ozagir fell sick on a trip to the US and bemoaned the fact that you could organise a taxi, a boat, even a helicopter through your phone, but not a doctor. Push Doctor does not attempt to triage or diagnose patients, but instead puts them straight in touch with GPs doing consultations during the time they could otherwise be doing private practice. An appointment costs at least £20 and a premium membership is the same price per month.

Other players in this market include Now GP and GPDQ (GP delivered quick). GPDQ can arrange for a doctor to come in person to a home, office or hotel in central London between 8am and 11pm, 365 days a year. The average wait is about 90 minutes.

The core message of all of these services is that they are not threatening the NHS, but working alongside it to reduce the burdens it faces coping with a growing and ageing population. Babylon, for example, has started a trial scheme with two GP surgeries in Essex where all patients can use the service free of charge. Early reports apparently found that the average waiting time for appointments came down by a week, to two weeks.

The development also fits with the idea that millennials now expect all their services to be streamlined and efficient: from getting the new ramen joint to deliver via Uber to having your dry cleaning picked up from your desk. David Mott from Oxford Capital, which raised £8.2m in funding for Push Doctor, even suggested the NHS should be left to the elderly and infirm, while time-poor 18-40-year-olds use the new app-based services.

Where Babylon seems to be taking the lead – and, Parsa believes, reducing the crisis of the global shortfall of doctors – is with its use of artificial intelligence. When I tried its “check a symptom” feature for the lump on my neck, I was actually being quizzed by what they consider the world’s first accurate AI triage service. In June, an in-house “live challenge” pitted Babylon’s AI against a senior A&E nurse and an Oxford-educated junior doctor. UCL professor Irwin Nazareth compared the results. According to Nazareth, “check a symptom” was consistently faster and more accurate in triaging patients than its human rivals: it scored 92% accuracy compared to the doctor’s 82% and the nurse’s 77%.

Push Doctor offers video consultation with NHS GPs, who can provide sick notes, referral letters and prescriptions.

This experiment was not the most rigorous of scientific evaluations, but it has shown enough promise for some heavyweight backers to get behind Babylon. In January 2016, the company raised £19m to further develop its artificial-intelligence platform. Demis Hassabis and Mustafa Suleyman, co-founders of DeepMind, the AI startup bought by Google for $ 500m, who had already been advising Babylon, invested, as did Richard Reed, Adam Balon and Jon Wright, the men behind Innocent Drinks. For Parsa, the next stage, probably as soon as next year, is that the Babylon app will be able to diagnose patients without a doctor ever needing to be involved.

“I’d trust a machine over a human any day of the week – and I already do,” says Parsa, whose background is in engineering, not medicine. He arrived in Britain as a refugee in his late teens and has been, among other things, an investment banker and co-founder of Circle, the private healthcare company that runs hospitals in Bath and Reading and in 2011 took over the struggling Hinchingbrooke hospital in Cambridgeshire. Parsa stood down as Circle’s chief executive in 2012, before launching Babylon in 2014.

“The machine doesn’t get worked up, it doesn’t get angry, it doesn’t get pushed because there are 20 people outside in the queue,” says Parsa. “A machine learns every time a diagnosis happens. A doctor might do 7,000 consultations. The machine will do thousands of times more. Therefore the speed at which it learns and everything it sees increases. So we believe in time we will do this more accurately than a human.

“Even the specialists. How many papers were published last year on dermatology? It was 11,000; 11,000 pieces of research that were worthy of being written down for somebody to take note. Which dermatologist reads this? They say, ‘Oh yeah, I spend my weekends catching up.’ How many can they read? So the idea that a human brain can keep in touch – ha!”

Parsa does not think that artificial intelligence will replace humans – at least not in the foreseeable future. But the potential is clearly there. He cites the example of DeepMind’s AlphaGo program, which inflicted a stunning 4-1 defeat on the 18-time Go world champion Lee Sedol earlier this year. The 3,000-year-old Chinese boardgame had been considered one of the “grand challenges” of AI because of its almost infinite number of possible moves. DeepMind puts the success of AlphaGo down to the fact that the program almost mirrored a human brain: it used trial and error, allied to a dense historical database of games from the past, to play both creatively and minimise mistakes.

“The one game AlphaGo lost was because the guy [Lee] did something that the machine had never imagined can be done,” says Parsa. “He used his intuition to say, ‘You know what? I’m going to do something very human here.’ As opposed to something very machine. And the machine got confused. So the methodology we employ is very similar to the way a human brain works, whereby we teach a human how to become a doctor and the same way we teach a machine how to become a doctor. We don’t just use ginormous amounts of data, we give them rules and functions.”

It takes around seven years to train a human to become a doctor – how long then for a machine? “Well, we’ve been at it for three years,” says Parsa, “so maybe it will take us seven years too.”

Not everyone is excited about the boom in online doctors. While there has been a rush by GPs to supplement their incomes with shifts at places such as Babylon – it has about 100 doctors on call – others are concerned about the impact that paid-for services will have on the NHS.

Now GP offers video GP services and can courier prescription medicines to your home for a fee. Photograph: NowGP handout

“General practitioners are a resource in short supply and in great need,” says Margaret McCartney, a GP in Glasgow, Radio 4 regular and author of the forthcoming The State of Medicine: Keeping the Promise of the NHS. “We as a profession are under huge strain and enormous pressure. These companies are essentially using market forces to determine access to GPs rather than need. GPs working in these companies will probably make more money and have a less stressful career. However, patients are far less likely to benefit. This might work in your favour if you are basically healthy, need a one-off appointment and have the money to pay to put yourself in the front of the queue. But if you have an ongoing condition, or multiple or complex needs, the research shows that your care will be better if you have continuity and are looked after by a team that can care for you holistically.”

The idea of “a GP in your pocket” emphasises speed and convenience, but McCartney fears that it may ultimately derail our health service. “These schemes may mean that you end up having to wait even longer to see your NHS GP, as the workforce becomes more depleted,” she says. “Some of these companies won’t see people with chronic diseases or mental illness. This kind of cherry-picking is rife in the private sector and I see these companies as the thin end of the wedge of sleepwalking us into an insurance-based model of healthcare. It needs to be resisted by everyone who cares about the values of the NHS.”

Parsa is aware that not everyone will approve of services such as Babylon. “Listen, there will be many comments from your readers that say, ‘That is brilliant.’ And there will be many that say, ‘That is awful.’ That’s OK. Think of anything: Facebook – lots of people say it’s brilliant and lots of people think it’s awful. But the existing model of healthcare we’ve got, guys, is nothing to write home about. One in five of us can’t see a doctor when we need to. One of eight of us gets misdiagnosed. About a thousand of us a month get killed because of avoidable mistakes. So the system we are protecting so much is good but it’s not great.”

There has been much discussion of the failure of Britain’s technology sector to produce a Facebook, Uber or Airbnb. Parsa feels that Babylon has the potential to become a similar, game-changing enterprise. Wired magazine recently named the company as one of Europe’s 100 hottest startups and the FT made a conservative valuation of it “in excess” of £77m. Babylon is certainly thinking globally; although its main operation is in the UK, the service is also launching in Rwanda, a country of 11.75 million people that has only a few hundred doctors.

Parsa insists that Rwanda is not a publicity stunt: it’s a country where mobile phones are commonplace and it has a progressive, if often heavyhanded, government. Besides, if Babylon can work in sub-Saharan Africa, then it should thrive anywhere. “In Rwanda or in many countries in the world, people are dying from things that a doctor can fix in no time,” he says. “So this is not populist. If you’re not doing it, it’s stupid. If you’re waiting two weeks to see a doctor and you can press a button and see it on Babylon, it’s not right.” A shake of the head: “That’s not right.”

Parsa is a convincing pitchman and my first experience with Babylon for my neck was a good one. But, until it becomes clearer how online doctors can coexist with our health service without diminishing it, it will remain hard to savour the benefits it can provide.

The doctor will see you now… on your smartphone

"If my disabled son still lived at residence, I would not be right here now"

The seismic shock of his early birth, followed by the grinding actuality of 24-hour caring with no support, led me in the end into a state of suicidal depression. I escaped simply because I had a comprehensive breakdown. Recognising that I couldn’t carry on, I used my expertise as a former lawyer to consider the council to court to get James into a residential school.

When the information broke final week that Tania Clarence, a good, middle-class mother in New Malden, south London, appeared to have killed her three disabled kids, I heard interviews with shocked neighbours saying how she had seemed so great, she had appeared to be so pleased and in control. We do not know what has occurred in Mrs Clarence’s case – that is for the courts to choose – but the feedback from the neighbours did make me believe about my circumstance. There was a disparity among the coping face I had presented to the globe and the awful reality I was living with at house.

It had probably been much more insidious due to the fact at very first we could cope. When James was discharged right after four months in the neonatal unit, we have been just grateful that he was alive. He was simply portable and particularly cute, with a ready smile and no clear motion problems.

Then he grew to become larger and heavier, and my back began to ache from carrying him up the stairs. He grew out of the nappies I could get at the supermarket and we had to have unique incontinence pads. The pushchair was replaced with a wheelchair, and a lift-hoist and ramps had been installed in our house.

Knowing James may never stroll was one factor. Obtaining his initial blue badge in the publish gave me the first of numerous days of searing emotional ache. James began to have seizures always at night, and mostly silently. I would locate him in the morning, often blue-tinged and staring vacantly, obtaining been sick. My sleep became restless with anxiety. I woke at every murmur, and would get up each time to check he was Okay. Once his stiff arm got caught in the bars of his cot and I raced in to find him in agony.

Then the nights took on a sinister new turn, as his autistic behaviour became far more pronounced. He would frequently move his bowels in the night and play with the consequence, generating what we came to call “poo-fests”. It took hours to shower him from head to foot to change the bed and disinfect the walls.

By the time James was 5, I had given up all thought of operate and was a full-time carer. In order for Andrew to function at his occupation, I had taken above most of the evening duty.

Andrew and I were residing in parallel universes. I was juggling numerous hospital appointments a week along with medicine charts and a cohort of visiting therapists. The therapists gave me jobs to do such as standing James in a particular frame, or stretching his stiff arm.

All the time I was stupefied by a lack of rest. Meanwhile, Andrew was attempting to come to terms with days that began with him calling an ambulance due to the fact James had stopped breathing, then continued with him putting on a suit and advising clientele.

Tom, our other son, had turn into silent and withdrawn, right up until one day he burst out that he must be the loneliest boy in the world. We realised that we had been so hectic caring for James that we hadn’t even had time to teach Tom to trip a bike. After that we took turns to get Tom out for a pizza or a movie. We couldn’t get James since he was, by then, so terrified of alter that he would assault us if we took him out of the home. The family was split and I, in distinct, was below residence arrest.

When James was 5, Andrew and I attended an appointment with James’s local community consultant, who manufactured the error of asking how we were. We the two broke down and wept. She asked us if we had any respite and we did not know what she meant. We discovered, then, that James was a “child in need” under legislation and that the neighborhood authority had been beneath a statutory duty to help him from birth. 5 years as well late, we had been appointed our very first social worker. It was then that we discovered the globe of cash-strapped councils, and inefficient social-companies departments.

It took a yr – and an appeal – to get two nights of respite a month, when James would stay at a specialist centre. At very first, to have even these minor breaks was akin to a survivor in a desert being offered a handful of drops of water. It saved our lives, and despite the tiny quantity, was intoxicating. We now had a baby daughter, Elizabeth, and we managed to give her and Tom trips out of the house, like normal households.

It wasn’t ample, although, and the inexorable downward spiral continued. I stopped currently being able to cope but, when asked how I was, I would nonetheless give a smile and say “fine”. The sense of unreality among the self I was presenting outdoors and the way I was feeling inside intensified.

I didn’t dare drop handle, because my outward composure was the only thing that made sense to me and enabled me to deal with other folks. What would we all do if I allow out the emotions of panic and hopelessness that had taken more than my lifestyle and just disintegrated?

But then I began to have photographs flash into my thoughts of drowning myself in our neighborhood reservoir. I did not prepare the ideas, they just popped up. I would all of a sudden be dreaming that I was at the edge of the water, with a ball and chain close to my ankle. I would be about to wade in to the amazing water right up until it closed above my head and shut out the chaos above. I never thought of hurting James or the other young children, and the suicidal thoughts remained just that: thoughts.

I watched Rosa Monckton’s documentary, When a Mother’s Love is Not Adequate, about mothers in my predicament who had contemplated killing themselves and their children (Monckton herself has a daughter with Down’s syndrome). I understood their logic that if they couldn’t carry on, they would take their children with them in buy to safeguard them. They didn’t want to leave them behind, being so vulnerable.

I have in no way wished James had died as a infant. Loving him has enriched my existence immeasurably and he is the bravest, funniest particular person I know. He has an iPad now for evenings, which is locked in a protected outside his bedroom at college. Following watching the workers open it a couple of times, he cracked the code, crawled more than and fetched it out himself.

He now lives a total and pleased lifestyle at Dame Hannah Rogers’ Trust in Devon, in which he is checked each 15 minutes at evening for his epilepsy, by nurses who perform shifts, not 24 hrs a day. We pay a visit to him each and every college vacation, and since of the expert psychological input he has had, we can take him out on trips. We have a wheelchair-adapted van, and he will come out with us to spots this kind of as the seashore, which we couldn’t have contemplated when he lived at property.

Some folks have even now found it difficult to accept how I could “let go” of the care of my son if I genuinely loved him. The reply is that I haven’t truly allow him go. I am nevertheless in charge of his daily life, and deal with his carers, medical professionals, social employees and teachers. We Skype him on his iPad and I send him letters and chocolate buttons every single week. To the extent that he cannot reside with us any a lot more, the solution is straightforward. If he had been nonetheless at house, I wouldn’t be right here now.

Jane Raca is the author of ‘Standing Up for James’ www.standingupforjames.co.united kingdom. For assistance on autism, go to www.autism.org.united kingdom

"If my disabled son still lived at residence, I would not be right here now"

3 Ways to Reduce Your Tension Ranges Right now.

one) Flip Your Radio off.
Most men and women practically do not get 10 minutes a day in silence. Regardless of whether you pay attention to speak radio or even music, try turning off your radio to and from work. If you have a thirty minute drive to perform, that’s an hour a day in silence. Enjoy the silence, gather your thoughts, and you will discover a huge difference on how you assault your day.

two) Meditate.
Most men and women have no idea how to meditate, or are intimidated by it. I hear a whole lot, there is no way I can turn my brain off and sit in silence. Let me inform you, if I can do it, any individual can. And like most things, you only get better with practice. Incorporating meditation in to your daily schedule will make a enormous influence in your anxiety levels. Begin with tiny blocks of time like five to 10 mins, as you get better you will uncover by yourself being in a position to sit for 20 or 25 minutes with ease. I desire to do it in the morning when I wake up. Discover a quiet spot that you will not be disturbed. Uncover a cushion or blanket that you can sit on. If you want to appear for one that is specifically created for meditation they are named zafu’s. There are a few different poses you can practice, full lotus in fairly hard for most men and women and needs quite a bit of versatility. You can Google what a half lotus pose looks like or my favourite pose is hero’s pose. There are a number of distinct choices with what you can do with your hands, I simply location them on my thighs in hero’s pose. This gives you a sense of getting grounded. Practice excellent posture, like a string is pulling your spine straight through the best of your head, like a puppet. Tilt your gaze, only your eyes, not your head, somewhat downward. If you hold your eyes open you can stare at a wall, or for novices closing your eyes might be easier to not let your mind wander. Begin by counting your breathes, 1 to 10, when you get to ten, start more than. If you discover by yourself pondering about one thing, recognize the believed, then allow it drift away, and start off back at counting.

three) Higher Intensity Surges.
Absolutely everyone understands that workout can support with pressure amounts, specifically tension hormones, but this can actually be carried out at your desk during your day. Select an exercising that you can do large intensity, like running in spot. When you are feeling stressed, run in area quick as you can for twenty seconds, then take a twenty second break, repeat three occasions. These are tiny surges that will minimize anxiety hormones like cortisol and get you moving.

3 Ways to Reduce Your Tension Ranges Right now.