Introduction
Historically,attending an appointment with General Practitioner (GP) was the first point of contact for patients entering the UK Healthcare System (Ingram et al., 2023). While only 17% GP consultations involve dealing with Musculoskeletal (MSK) conditions the recent increased pressures facing GPs has led to the emergence of a MSK First Practitioner Role (FCP) to off set patient demands elsewhere (Ingram et al.,2023).
The MSK FCP role is distinctive in its first contact nature, bringing an additional layer of responsibility and the challenge of managing clinical uncertainty.This uncertainty, prevalent in primary care due to varied patient presentations and time constraints, may adversely affect decision-making and increase the risk of over-investigation and litigation (Ingram et al., 2023). Furthermore, diagnostic challenges require MSK FCPs to possess extensive medical knowledge beyond the musculoskeletal system (Ingram et al., 2023). The emerging nature of the MSK FCP role means practitioners face numerous uncertainties, which could have significant implications for their wellbeing. Studies highlight concerns over the potential for these uncertainties to affect job satisfaction and retention (Ingram etal., 2023). Furthermore, reports indicate an inadequacy of support and supervision provided to those in such innovative roles, signalling an urgent need for further exploration into cost-effective strategies that may influence MSK FCPs' sustainability and overall mental health (Ingram et al., 2023).
A potential solution to address the challenges currently facing MSK FCPs and those alike is to incorporate recent technological advancements into clinical practice. One approach would be to make use of speech recognition software to enhance the efficiency and quality of documentation process during time stringent consultations (Ajama, 2016). Traditional documentation faces numerous challenges, including data inaccuracies, illegible reports, and in complete records, leading to substantial impacts on medical record quality and, by extension, patient safety (Ajama, 2016). Reports indicate that documentation errors contribute to a significant number of fatalities annually in Western Society (Ajama, 2016). Moreover, manual documentation has been identified as a major source of dissatisfaction among healthcare professionals, adding further to the stress levels of clinicians (Ajama, 2016).
The adoption of speech recognition technology in healthcare aims to alleviate the pressures on clinicians by enabling more efficient and accurate Electronic Health Record (EHR) documentation (Ajama, 2016). This technology may offer a cost-effective alternative to conventional clinical documentation methods, potentially reducing the manual input from MSK FCPs thereby allowing more patient interaction. However, it seems the current focus of most speech recognition technologies is on transcribing clinicians' speech rather than capturing the entirety of patient-clinician interaction, perhaps due to data protection laws, but would nevertheless limit the effectiveness of such an approach. Additionally, the capacity of such technologies to organize and document non-linear conversations into coherent and appropriately sectioned EHR entries remains an area concern. Furthermore, speech recognition software used healthcare settings would be required to offset the ambient noise in open clinic settings to ensure the unauthorised documentation of nearby consultations is prevented.
Another challenge facing practitioners is the requirement to maintain high standards of patient care while staying up to date with best practice guidelines for many conditions. Unfortunately, the flames have been fanned by the increasing pressures on GP’s, which has caused a shift in more patients accessing rehabilitation services privately or through direct access without prior screening. While these options offer earlier intervention it has unknowingly thrust many practitioners into position of first-line practitioners, who are required to consider conditions beyond musculoskeletal issues. Without proper measures, this shift increases the risk of patients with serious underlying conditions receiving misdirected, and potentially harmful, treatments based on misdiagnoses as musculoskeletal injuries.
A case in point involves patients with shoulder tumours being misdiagnosed as having a frozen shoulder, resulting in several months of ineffective treatments before receiving the correct diagnosis. Now, should they have ordered an x-ray to confirm frozen shoulder? Maybe, but it is not astandard across all trusts. What might of helped is an automized pre-screening process to systematically outline potential conditions, identify comorbidities, and detail management strategies and referral criteria for relevant each condition. Here’s where algorithms come into the discussion. It is not to be used as diagnostic tool but to prompt the clinician to asking the right questions. Now, I understand that using algorithms in healthcare seems at odds with current drive for patient cantered care, but I feel something needs to be in place to screen patients for other conditions in light of the sudden shift of clinicians taking on the role of a first line practitioner.
Another potential strategy to reduce the burden on MSK FCPs is the integration of Artificial Intelligence (AI) into the healthcare system. Currently, we find ourselves at a pivotal juncture where the adoption of AI in healthcare could offer unparalleled opportunities to enhance service delivery and patient care. From less sophisticated screening algorithms to more advanced chatbots, AI could reduce the number of cumbersome duties and automate routine tasks with greater consistency. However, integrating AI into healthcare practices is not without its challenges and requires careful consideration of ethical issues and data privacy. Furthermore, though it is small proportion, clinicians still have negative connotations AI will negatively impact their job security (Alsobhi etal., 2022).
Additionally, as AI makes further advancements in its capabilities, the need for oversight increases and ensuring that AI assists, rather than hinders, the clinical judgment of practitioners becomes paramount (Alsobhi etal., 2022). In response to these evolving dynamics, a new profession might emerge that bridges the gap between clinicians and AI. This role could involve professionals trained in both healthcare and AI technology, who specialize in integrating, monitoring, and managing AI systems within clinical settings. These specialists could ensure that AI implementations are ethical, effective, and enhance clinical outcomes without undermining the autonomy or expertise of healthcare practitioners.
Such a role would not only mitigate concerns about job security by creating new career opportunities but also play a critical part in the successful adoption of AI in healthcare. This new breed of healthcare professionals could be pivotal in training staff, guiding the ethical use of AI tools, and providing the necessary checks and balances to maintain trust and reliability in AI-assisted healthcare services. By doing so, they would ensure that AI acts as a supportive tool that augments, rather than replaces, the critical human element in healthcare.
The introduction of MSK FCPs within the UK Healthcare System marks a pivotal shift in addressing musculoskeletal conditions directly at the primary care level. This emerging role, aimed at off setting the growing demands on GPs, introduces both unique opportunities and inherent challenges, particularly in managing clinical uncertainties and the broad spectrum of patient presentations. The adoption of advanced technological solutions, such as speech-to-text software and AI, presents a promising avenue to alleviate some of these challenges by enhancing documentation efficiency, improving patient care, and supporting clinical decision-making.
The integration of speech-to-text technology in healthcare settings has the potential to significantly reduce the manual burden of documentation on MSK FCPs, allowing for more interactive and patient-focused consultations. However, the effectiveness of this technology is contingent upon its ability to accurately capture and organize complex clinical interactions into coherent EMRs, while also ensuring patient confidentiality in open clinical environments.
Similarly, the incorporation of AI into healthcare offers the possibility of automating routine tasks, aiding in patient screening, and providing decision support through predictive analytics and intelligent chatbots. Yet, the successful integration of AI requires careful navigation of ethical considerations, data privacy concerns, and addressing the negative misconceptions from clinicians. Moreover, maintaining a balance where AI supports rather than impairs the clinician's decision making is crucial to preserving the human element in healthcare.
As we stand at this inflection point of technological advancement, it is imperative for healthcare systems, clinicians, and developers to collaborate closely. This collaboration will ensure that technological integration is leveraged effectively to enhance the MSK FCP role, improve patient outcomes, and foster a healthcare environment that is both innovative while remaining empathetic. Through thoughtful integration of technology and continued research into its impacts, we can address the challenges facing MSK FCPs and pave the way for a future where technology and human expertise work in harmony for the advancement of patient care.
As we stand at the crossroads of tradition and technology, it's clear that the future of our industry remains in our hands. Though we need to be mindful of the exponential pressures on healthcare as a whole, a problem that we cant seem to outrun without the adoption of other resources. The way I see it, a partnership wth AI and advanced technologies will serve as our trusty sidekicks hiding in the shadows. I think people who envision a mass march of us protesting in the streets shouting "they took our jubs!" likely dont value the essence of our professions: the irreplaceable human connection, empathy, and compassion that forms the backbone of effective patient care. Eventually, I imagine these technologies will lighten our administrative burdens, sharpen our diagnostic acumen, and personalize patient care in ways previously imagined only in The Jetsons.
I see it more of inevitability at this point, advances in AI and those alike will be incorporated into all Healthcare whether we like it or not but it's important to remember that technology is a tool, not a replacement. So, as we gaze into the crystal ball of healthcare's future, let's not worry over our digital counterparts. Instead, let's welcome them into the fold, recognizing their potential to support us in our mission to provide effective and efficient care. This leaves us humans free to focus on the essence of healthcare – developing a connection in the face of adversity. After all, in a world increasingly ran by faceless technologies, the power of human touch will only be enhanced further – a tool no machine can replicate, even if it does learn a few jokes.
