Gurnak Singh Dosanjh speaks about his life as a GP, his interest in digital healthcare and work with Dignio
Can you introduce yourself and tell me about your current role?
My name is Dr Gurnak Singh Dosanjh, and I am a GP with an interest in digital transformation and digital healthcare. I have been a GP now for almost 9 years and still enjoy the challenges that primary care brings, as much as I did on my first day!
I also collaborate with digital companies, my current role is with a company called Dignio, where I am the UK Head of Clinical Solutions. My role is to be the bridge between clinicians and technology. I help clinicians understand how the technology can support the clinical pathways that they are trying to improve across the integrated care system.
I am also passionate about tackling health inequality as well, so I do wear quite a few different hats you could say!
What made you want to go into medicine, then what led you to becoming a GP?
Family upbringing, early education and my religious background, has always taught me from an early age to try to help others. I have always had an interest in how things work from a young age. With an inquisitive mind, it was small, simple things that really got me interested in not only human biology but also the psychological side of things. I was always asking questions like, what makes a cut stop bleeding or why do we dance when happy and cry when upset. And would then go and read about it. Being naturally curious and wanting to help others, really helped shape my mindset through my educational years.
I had a lot of support from my family, and it felt like a natural step to explore medicine as a career, as I thought it could be a good way to help people in many different ways. If you really think about it, most people need help and support, both physically and mentally when their health is not quite right. That was what led me to thinking about going into medicine, and then my family encouraged me to pursue it.
“I saw general practice as a specialty in being a generalist”
In terms of becoming a GP, I have often seen myself as a Jack of all Trades. Lots of people have this thought that GP is not a specialty; but I saw general practice as a specialty in being a generalist. This gives me the chance to help patients across all sorts of challenges and issues they may face. And that value is still true in primary care today, no day is ever the same. I can go from seeing a child with a skin condition, to seeing an elderly patient with a recent diagnosis of cancer, to seeing someone who might be struggling with alcohol issues all within the space of 30 minutes!
I have always liked variety, and I have always liked to think about how illness can affect beyond just the physical aspect. Being a GP always feels like a really privileged position. Often someone who I may have never met before, trusts me enough to share details about their personal and social life, their physical and mental wellbeing, their deepest concerns and sometimes their biggest fears. Often these are things that the patient may never have said aloud before, so being a GP really is unique and I am always grateful for the opportunity that it gives me to make a difference in people’s lives.
How do you think the impact of the last 12 months will affect primary care over the coming years?
Unfortunately, but inevitably, there will be a big fallout from the pandemic across the NHS and we are already seeing some of the effects that this has had. There have been delays in patients seeking help, and this means that patients may be more unwell when we see them. Generally, there has been a massive impact on mental health for patients and staff. I also think a lot of things have been pushed down the field. Operations that would have happened, have been delayed, patients who would typically get hospital care have been held up and all of this will create more pressure on the system. There will be a big burden of healthcare issues that we will have to deal with.
Teamwork across the NHS
There has been an incredible amount of teamwork across the NHS and there has been a real sense of camaraderie. It was an all hands-on deck approach, with everyone supporting each other across teams, both primary and secondary care. I am incredibly proud of what NHS staff have managed to achieve given the unprecedented situation of the pandemic. NHS staff have shown that they are there for their patients at a time of real need. If we just look at the vaccination programme and how primary care supported it to get record breaking numbers of people vaccinated.
There has been lots of innovation and the pandemic has helped move things forward rapidly. Lots of people have started asking how things can be improved. An anaesthetist colleague looked at the issue of how people communicate in hospital when staff and patients are wearing masks. She came up with a simple solution called CardMedic to help solve this challenge, which has now been used in over 120 countries around the world! Dignio used its technology to help set up virtual wards, so that clinicians could safely monitor patients with Covid-19 and other conditions during the pandemic.
I am hopeful that some of the positive learnings and innovations from the pandemic will help us move forward post pandemic.
What have you learned from over the pandemic?
Lots! The main learning for me was the outstanding ability of NHS staff to dig deep, and how to really go that extra mile for the patient. This isn’t just a sound bite, this is something I have personally seen on many occasions during the pandemic and has helped me learn new ways in which I can support patients. There has been a lot of good will from NHS staff, and I hope that as we move forward all of this good will is not forgotten. I say staff – I don’t just mean clinicians. I mean all staff; porters, cleaners, nurses, students, all of them!
The other thing I have learned during the pandemic, is the importance of being supportive. There have been lots of positive messages about ‘being kind’, but sometimes it can be easy to assume that someone is coping well and doing ok. The truth is that we have just gone through something that none of us have faced in our lifetimes, everyone has been affected by the pandemic in one way or another. So being supportive, reaching out to people if you feel that something is not right and just generally being kind is a big lesson that I hope all of us take forward into the future.
What advice would you have for medical students thinking about general practice?
I always encourage any medical student to be inquisitive, ask questions, lots of questions! Firstly, ask yourself ‘What do you enjoy?’ Could general practice help you achieve the areas that you enjoy? There is quite a lot of overlap in general practice, I have colleagues who do minor operations for example, and others who are specialists in particular fields like dermatology, cardiology and so on. Even myself, I have a nice balance between digital and clinical. So general practice can really help you find the right balance. Use your clinical placements to get a good feel of what you like and equally importantly what you do not like.
The second thing I would say is to look at your strengths. We all have strengths. I am a firm advocate of working on your strengths and using them to help you move forward in your career. That is not to say that if you are strong at one particular thing, you cannot develop other strengths, you can. The nice thing about general practice is that you can have strengths in a variety of different areas, and still have an opportunity to be a brilliant GP as there is so much variety!
And finally ask some more questions! This time ask your mentors and trainers about their experiences of general practice. What is their day like? What do they do on a day-to-day basis? Or what do they like and what do they dislike? I can say no day is ever the same! And I never know who is going to walk through my door next. I have to explore and sometimes dig deep to understand the patient’s ideas, concerns and expectations; but I enjoy that. I like the fact that I see a lot of variety.
Almost all clinicians that I know would be more than happy to help answer questions and share their experiences with junior colleagues. Do not be scared to ask those tricky questions!
What is the best advice you have received from another GP, and what advice do you have for people working in general practice at the moment?
I think it is fair to say that most clinicians at some point in their life will have “Imposter Syndrome.” This is where you might feel like a fraud in the role that you are in, or you just got there because of luck. I have often had Imposter Syndrome, and still get it to be honest.
The best advice I have ever had helped me reflect on this feeling of Imposter Syndrome and it came from a senior GP colleague. It is impossible to know everything about medicine, and we always have something new to learn and something more to offer our patients and colleagues. That humbleness and willingness to learn and reflect can help us be the best doctor we can be for our patients. So, the advice was to focus on my strengths and never be afraid to continue learning. So rather than saying “I don’t know” I now say, “I don’t know, yet.”
In terms of advice for people working in primary care, I think my advice would be simple. Continue to be kind, to yourself and supportive to your colleagues. We have all gone through an incredibly challenging time over the last 12 months. And we are still learning how to cope with it. There is still lots of uncertainty out there. Reach out to those around you if you are struggling. Sometimes we primary care staff feel that they need to keep going even when things might not be quite right. Which can be unsafe and not good for personal wellbeing. It is OK to slow down, to not be OK. It is OK to reach out, it is OK to talk.
Can you tell us more about your interests in digital healthcare?
Digital healthcare came by accident! I have a big passion for recycling and was involved in digitising processes for our family recycling company. Everything was paper based, and in the process I accidentally ended up creating an app to help people recycle! I actually learned a lot from that process. I found that I carried some of my skills that I had developed as a clinician, into the world of entrepreneurship. You end up wearing a lot of different hats and overall it was an incredibly good experience.
It felt natural to merge the passion in technology with my experience in clinical medicine with an aim to support and improve what is out there for both patients and clinicians. Now I see digital technology as a way to really improve healthcare for patients, reduce health inequalities across the board and make healthcare readily accessible for everyone.
Dignio, Digital Healthcare
My current role with Dignio is aimed at supporting clinicians and helping colleagues understand what technology can do today. We often talk about the future of digital healthcare, but in my mind the future is here now. We have sophisticated tools ready to go. Which can be used to merge the boundary between health and social care; for integrated care provision across a spectrum of clinical conditions. It is nice to have a role in the digital health world. Where I can encourage and support digital transformation by showing the art of the possible.
Thinking about these issues like health inequalities and avoiding complex systems for patients to navigate; makes it really interesting to work with cool teams like CardMedic and Dignio. They are really good examples of how technology can be used to make a positive impact. CardMedic is a great example of how a simple idea to improve face to face communication between patients and staff, can be used across the world; to make a difference to patients.
Finding the balance
For me, I think it is really important to still be a clinician on the ground; at the coalface so to speak.
My clinical hat helps me understand the pain points that patients and clinicians experience. Whilst my digital hat helps me understand how the technology can support the changes needed to solve the problem. My clinical hat reminds me that digital transformation should methodology first and technology second. Ensuring that patients and clinicians are at the heart of that journey.
It is great that patients often share with me how they feel things can be improved. For example, let us imagine a patient with diabetes, who then develops kidney issues; and later gets diagnosed with cancer and subsequently develops mental health problems. Right now that patient would need 3 or 4 different apps; because most health technologies see an individual as a single disease process. But in reality a patient is a patient, not just COPD or diabetes or depression. The patient is on a journey and needs different levels of support at different stages.
That is why I enjoy working with Dignio. It gives me the opportunity to help bring all that support into one place for a patient; a real one stop app for the patient. Because Dignio is flexible and customisable; I can help clinicians configure it. So, that a patient can be supported across multiple comorbidities and throughout their care journey.
It is also genuinely nice when some of that work gets recognised. We recently won an award for Driving Digital Transformation. This was part of our work with Dudley CCG and Covid-19 monitoring at home. It was also nice to hear how Mastercall created Technology Enhanced Living using the Dignio software. This has reduced hospital admissions by 37% which translates to a 2.5 million pound saving to the health ecosystem!
What do you see as the future of digital healthcare?
I am a big fan of saying that the future is here now. The tools and software we have available now are far more advanced and capable than we realise. In my mind the technology is the easy part. The challenge is how ready are we as a system to adopt and implement the technology.
With the forthcoming White Paper reforms; it is really important that the system starts to look at how we can adopt these services; now and across the ICS. So, we can start to see real benefits to patients, clinicians and the health ecosystem. We need to start thinking about how digital tools can follow a patient through their whole care journey. From when a patient is independent to when they might need home support or go into a care/nursing home.
Can the tools follow the patient or are they only built for one part of the journey? We need to start looking at the patient as a whole, not just a single disease process. And the apps need to reflect that. We need to be careful not to further fragment care by having lots of different apps for different conditions; as this will just make it harder for patients. We need to be careful not to inadvertently increase health inequalities.
There are lots of great people out there who are working hard to help demonstrate what digital can do; but I think we need more digital champions. People who are digitally minded, who understand tech and also understand the clinical side of things. These digital champions can help make sure that technology remains patient centric. That is the exciting part of digital healthcare. With the right tools you can really scale and improve healthcare for patients.
I look forward to seeing software like Dignio support patients across the Integrated Care System; and apps like CardMedic breakdown language and communication barriers. It is an extremely exciting time to be involved in medicine and digital healthcare!
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