Last night I got home at 9 after another long day at the practice, this time without being on call.

I'm sitting with my second coffee on a day off.and thinking about the impact of Covid-19 on general practice, the medical discipline I love.

There's good and bad so stick with me

Like @HelenRSalisbury says quite often in the @bmj_latest I miss close interaction with patients.
Like all GPs we're not closed and I still do F2F consultations were needed.
But the vast majority of consultations are on the phone, supported by photos and video.
This is not easy.

Remote consultation is difficult to do well and it's stressful.
What am I missing because I can't see you? What are you not telling me?

But here's the thing; to do it well takes time, quite a bit more than you'd think.
Because you have to really listen.

I had several consultations after the surgery had formally closed, in part because of having to navigate the new Covid Virtual Ward system.

Two of my last calls were follow ups from other GP's investigation results.
Both took almost half an hour to do.

The first will make @mancunianmedic smile; I spoke with an acute medical colleague at my local NHSTrust; we know each other only through "advice and guidance" calls. I respect him and like to think it's mutual.
We were able to agree so as to keep the patient out of hospital.

The patient was delighted and despite the seriousness of the situation, was able to laugh and had a positive outlook.
She then told me she had asked for me and was prepared to wait as long as she had for my call.
"I knew you'd call me no matter how late - you always listen."

The second was new to me so I tried to unpack my colleagues thinking when the bloods were requested. It seemed to suggest the patient wanted HRT.
Her opening words were "I don't think I need HRT."
I asked her to tell me what she thought, and listened.

The main issue was complex chronic pain with some extra things thrown in for good measure.
I checked she'd told me everything she wanted to, asked a few questions then said, "This is what I'm hearing, please stop me if I'm wrong..."
When I'd done she burst into tears.

She felt listened to and heard.
She felt her worries and issues had been taken on board.
We formulated a plan and a review when I'm back off leave.

The point of this long ramble?
GPs can still connect with their patients remotely but we really need to listen.

We need to respect what we're hearing and work with patients and colleagues towards a safe and positive outcome.

As I said, remote consultation isn't easy. It's hard.
But it's worth it for everyone when done well.