Raising the Stakes with COVID-19

by Dr Anne Stephenson, Torquay General Practitioner and Western Victoria PHN Clinical Spokesperson

In the absence of any formal measures, I find that one of the best litmus tests for how I am travelling as a GP is how I treat my family, and in particular, how I treat my husband. Without going into detail, let’s just say that over the last two weeks I haven’t been an angel at home.

So my question for health practitioners is this: how are you going with the new reality of general practice with COVID-19? Or should I ask how is your nearest and dearest coping?

Adapting our practices

Every day I’m swamped with a huge amount of information, news and updates about COVID-19. There are new ways of practicing medicine, new ways to receive and exchange information and new ways to actually run the business of general practice. We then need to distil this changing landscape for our workplaces and patient community. Many patients are elderly and not IT-literate, and social media or email updates are not always the best way to get information to our community.

It’s been interesting to watch the evolution of how we are adapting our practices to deal with the pandemic situation. Many practices, including mine, are swabbing for the virus in our car parks to prevent the virus from entering our sacred space, and asking our patients to wait for us in their cars before they come in to see us.

With the new telehealth/teleconferencing item numbers, we are doing much of our consulting remotely through teleconferencing or over the phone. GPs have universally embraced this initiative and it has come a long way to keep us on board with the fight against this terribly contagious virus.

When you walk into our general practice at the moment, it is strangely quiet and calm – the usual tatty out-of-date scandal magazines, unread health leaflets and broken kid’s toys are gone. But the strangest thing of all is there is no one there. The usual hubbub of people and their chatter is absent, and it feels kind of desolate, almost nothing like the general practice waiting rooms of old. It’s quite disconcerting arriving at work, but the hectic pace quickly resumes once I’m in my consulting room.

Important questions to consider

Many doctors have asked: is this the calm before the storm? As more people start to get acute respiratory distress syndrome from this virus – and they will – it will get more difficult to manage. Are we going to be trying to assess our older patients with comorbidities in a telephone consult to ascertain whether they should go to hospital? Should we be starting to talk to all our patients about what their plan is if they get the virus? Absolutely, we should. Any patient being admitted to hospital may not survive and may not see their family again. Especially if they are elderly and/or with comorbidities.

Steve Carroll, a US emergency physician said last week: “Patients are arriving without family or friends. Now we make sure they call their family before we put them on a ventilator. Because they may never get to speak to them again.”

While it is overwhelming and there is so much to get our head around, it is time to get serious about having end of life conversations with our high risk patients about the possibility of coronavirus and what would they do in that scenario.

If anyone would be interested in doing more URGENT work in this space, please get in touch with me via email at doctoranne@netspace.net.au.

Good luck to everyone (and their partners) over the coming months.