Kieran Walsh: Seeing a gatekeeper to see a gatekeeper 

Could a robot do the job of a GP? At present, most people would say no or not completely. But some say that a robot could take simple tasks away from a GP and so reduce their workload and save costs. Some say that a robot could act like a gatekeeper to a GP. [1] The robot could diagnose and manage certain patients and, when it could not, it would open the gate to see the GP. 

The main argument for such a system is that it might save costs by reducing the workload of expensive healthcare professionals. However, there are arguments against this way of doing things. The gatekeeper robot might make a mistake and falsely reassure or unnecessarily refer a patient to see a GP. In the first case, the patient might follow the advice of the robot and then return when the advice didn’t work—resulting in a delay in diagnosis. In the second case, the result could be overdiagnosis and overtreatment. As well as poor quality care, both scenarios could result in increased costs to the health service in the long term.

There is also the issue of the phrase “gatekeeper”—which might not be in keeping with the concept of patient-led decision-making. Surely patients should have a say on what gates are open to them? At present, they can talk to their GP, but will they be able to talk to a robot in the same way? Then there is the problem of the robot taking all the patients with straightforward problems and leaving the GP to care only for complex patients. This approach can exhaust the healthcare professionals that it is purporting to help. Lastly some patients might see a robot first and then see a GP who might realise that they have a serious problem and need to see a specialist—thus seeing a gatekeeper to see a gatekeeper. Similar outcomes could occur when allied healthcare professionals first see patients in primary care—but this depends on the exact role and function of the allied healthcare professional.  

In summary, putting a gatekeeper in front of a GP might save costs, but might also cause problems. However, an irony is that this is being discussed at a time when the traditional function of gatekeeping in general practice has been questioned. [2] At BMJ Best Practice, we provide clinical decision support to any healthcare professional who thinks they will benefit from it. It might not be long until robots ask if they can use it. What will we say then? 

Kieran Walsh is clinical director of BMJ Learning and BMJ Best Practice. He is responsible for the editorial quality of both products. He has worked in the past as a hospital doctor—specialising in care of the elderly medicine and neurology.

Competing interests: Kieran Walsh works for BMJ, which produces the clinical decision support tool BMJ Best Practice. 


  2. Greenfield GFoley KMajeed A. Rethinking primary care’s gatekeeper role. BMJ.2016 Sep 23;354:i4803.