Twitter is fantastic as a place to have great conversations that wouldn’t be possible without this digital space – I love it – but again today I had another fantastic Tweetup, that is a face-to-face meeting with someone I first met on Twitter. It seems to me that as my twitter relationships evolve I instinctively want to make the effort to meet the person face-to-face. For me, it seems that for the required depth of some of the relationships, digital just isn’t enough. So what happened today was a little bit of face-to-face magic with @smclrk where I learnt so much and started to form a relationship that I hope will endure, that Twitter conversations alone would never have achieved.
This led me to think about some of the debates about using technology to deliver care – is digital enough? Many readers of this blog are likely to have read my earlier blog ‘To Whom it May Concern’ – it’s one of my most popular postings – and are likely to note that I seem to be advocating less face-to-face and more digital. Similarly Roy Lilley’s (@roylilley) blog for the KingsFund ‘It’s crept up on us’ is saying similar things; we need to recognise that in the world we know today surely technology has a greater role and place. I whole heartedly agree but I find the debates that this generates distracting and extremely frustrating.
The trouble is it sometimes feels like we are looking for a silver bullet, or a single direct approach or solution to the complex challenges we face in delivering care in a changing economic and societal landscape – in truth there is no one solution. 
So why then do commentators persist in saying you can never replace face-to-face with technical solutions, implying that advocates of technology are saying this is the single way? I have never heard any advocate of new ways of using technology or innovation say that this is the case! What they do say is that for some processes (ordering repeat prescriptions for example) or transactions (a query about diabetes control from an experienced patient via email) technology can play a part.
When I went to work at NHS Direct in 1999 I remember being told by other nurses that you can’t care for patients over the telephone. 
I think this debate is past us now with lots of care being delivered using the telephone; but this is also not without its controversy, if I ever tweet or talk about my personal desire for telephone consultations someone will comment or question to say that I ‘don’t understand’ and that we should always use face-to-face and my heart sinks. I have never said or suggested that we could completely replace face-to-face care. As a person with a long term condition I can say for me that technology can have a role that will improve the quality of my life and (maybe) reduce the cost burden of my multiple hospital visits but equally I need to see my Diabetes Specialist Nurse sometimes for a different sort of conversation that cant be achieved on the phone or via email.
So, is digital enough? I say that it isn’t, and never will be, but it must have a role. Like my experience on Twitter some remote digital relationships are enough but for some, face-to-face is the way to go. My suspicion is that digital will have an increasing role in healthcare but it will never replace the dialogue that we have as human beings who occupy the same room. My plea is can we be balanced in our approach to adoption of new approaches to delivering services using new technologies that may improve the quality of life for some people?
anniecoops 
Annie, you bring up lots of issues here.
‘Digital’ is certainly seen as a magic bullet by the Government and has ever thus been so since the mid 90s. Unfortunately, it has its hidden ‘costs’ too (not just in cost for the tools to use digital means but in the social, cultural and organisational changes that have to be made to accommodate the disruptive and displacement effects that Digital brings along with it). I think we are only just beginning to see some of these costs emerge.
I have a feeling that communication patterns emerge and are sustained because the parties on either side of the exchange contribute to both the building up and sustaining of that model. hence in times of pattern reformation (which we are surely in at the moment), there are going to be participants who see it as a ‘power’ struggle between one form or another form.
Like you say, Digital has its strengths and weaknesses and it will never replace a Dr’s visit to an elderly housebound copd patient or a patients visit to a HCP where they may just want their hnd to be held (literally or figuratively). We’re human beings after all, the need for face – face communication will always be there.
Anne a thoughtful article. I completely agree with your sentiments that Digital elements are just a set of tools, and use of digital media it should never stop the necessary human-to-human interaction.
That said it offers elements of interaction that we have traditionally don’t use, for example consultations over wide distance can be supported by digital tools including camera and two way interaction. Some may feel this affecting the therapeutic relationship, I personally see it as a means to the goal of supporting care.
We must be aware that the internet and its associated products will not go away as such we should harness then to support care delivery in all care settings. And as Many has pointed out be cognisant of the impact when using digital approach means, both to current work practices, organisational delivery, culture and ease of use.
I have said it before and I will say it again ….. there are times when (shock, horror) digital is not always appropriate. I totally agree with your blog post and if we take it out of healthcare for a second and look at our social habbits we all like to post on our friends facebook wall, to text them and to tweet them but nothing beats a good sit down with a cup of tea and a slice of cake and a good friend. Yes digital is helping us to connect more easily but as you say balance is key. Brilliant blog post – thank you for sharing it
Well said. and thank you for saying it. ‘digital is enough’ a typical strawman argument. I am not aware of any serious person who believes and that and that includes uber digital enthusiasts.
And this ‘face to face is best’ is a red herring.
Let us say that I am a person who prefers face to face interaction with my physician but because of poor digital access the process of engineering that encounter is unnecessarily hard. It has to be done by telephone between certain hours of the day and every conversation I have is hurried, inattentive and often patronising. I don’t want to replace the face to face component of my physician interaction but I don’t want to have to swim through a river of crap to be able to earn it.
Of course, the real reason for having this river of crap is very different. Firstly, there is no incentive to not have it. GPs like to be protected from uncontrolled access to their precious time and the army of rottweilers barking down the phone gives their lives a semblance of control. Also, one GP told me that his receptionists were not very enthusiastic about handing out people EMIS access codes to every patient because that would eventually make some of them redundant (or st least thats what they thought).
The reason why digital is unpopular in the health service is because like most other industries digital efficiency inevitably means loss of jobs.
You know the cheap ticket you got on Kayak to South of Spain last summer? A part of your saving came from the commission that went to the travel agent who got fired. When it happened to travel agents we said, tough, it is better for the consumer so viva la change and because they were not unionised.
The battle for ‘digital’ is not about replacing face to face contact, it is about making it possible to use the resources of the NHS more effectively by using basic digital tools. Misrepesenting the intentions of those who are championing digital technologies plays into the hands of those who fear change.