Welcome to our blog.
March 2020 saw us abruptly shut our doors, pull out our old hospital scrubs from our kids’ dress-up boxes, clear all but the essentials from our clinical rooms, dump waiting-room magazines and toys and scatter excess furniture to the far corners of the building.
We scavenged personal protective equipment (PPE) and repeatedly doused the place in antiseptic.
Weekends and evenings were spent re configuring our practice and learning everything we possibly could about this new virus: So little was known and yet there was so much to read and discuss.
We wanted to know what impact it had on children, on those with medical conditions, on the elderly, on pregnant women….but no one could possibly know, as it had only existed in the world for less than a single trimester of a human pregnancy. All we had were small studies coming out of China which raised more questions than answers. We were horrified by reports from Lombardy, then Dublin, then south Galway.
We became familiar with Zoom meetings and webinars and Worldometer. Local colleagues pooled resources, algorithims and updates. We added the HSPC website and online ICGP Covid Hub to our favourites tab.
We cancelled holidays.
We volunteered to staff the local Respiratory Hub in Merlin Park, the hospital originally built as a tuberculosis sanatorium.
We practiced doffing and donning.
We debated how we could best manage our patients safely. All of our encounters in General Practice are enriched by non-verbal communication. Very abruptly we were without the reflexive and reassuring smile or touch that can put an anxious patient at ease. Usually, much of our clinical assessment is already completed by the time we have watched our patient stand up in the waiting room and walk down the corridor. Through years of practice, we are attuned to picking up on unspoken cues. We had a slew of people contacting us with symptoms of possible Covid 19. We noticed that people were not contacting us with any other potential illness and concerned, we reached out to our most vulnerable to reassure them we were still here if they needed us. We deferred routine, non-urgent tests and reviews.
We prepared for a devastating wave of Covid and planned for how we would cope if our local hospital, Galway University Hospital, became overwhelmed and we needed to attend to our dying patients at home. We stocked up on medications that might allow us to give comfort where cure was not possible. We considered setting up beds for ourselves in the surgery. We set up Virtual Private Networks to our homes so that we would have contingency to be able to work remotely if we ourselves became infected.
We worried about our families. Like the rest of the population, we stayed away from all but our closest members. Our pre-schoolers learned to reserve their cuddles until we were showered and out of scrubs. We insisted our parents cocoon.
We have stayed away from each other. Each of us has squirreled away in our own clinic rooms, initially for weeks and now months doing phone and video consultations. We only ask limited patients to attend the surgery; only those who need to be physically examined or have blood drawn or be injected with some remedy or vaccine or be provided with some form of therapeutic intervention not deliverable by phone or email. Those patients who come, we meet be-masked at the door with the “Covid handshake”; a shot of 70% alcohol into the hand. We thank them for wearing their face masks, though it is such an odd new necessity. We reflexively wipe door handles and surfaces. We smile behind our masks as we welcome them into our sanitised rooms.
During the height of infections, we took turns to see those with respiratory symptoms in full PPE each afternoon in a designated “respiratory room”. We got a jolt when the first of many positive Covid swab results came back on one of our own patients. We were relieved that we had taken the threat seriously and we continue to do so.
At reception, we now keep the door shut and Perspex screens in place to reduce the risk of droplet spread. Our indispensable reception staff have adapted and shown such resilience and teamwork during the scariest of times when our plans for how we do things sometimes change between morning and afternoon.
We have grown accustomed to telephone consultations. We are getting more proficient in identifying who we can reassure, who we need to treat and who we need to physically see for ourselves before deciding on a course of action. Consultations by phone often take longer. Video consultations are often hampered by poor connections. Emailed photographs are often pixelated or taken so close to the body-part that they are indecipherable. But we have muddled through. The good-humour and resilience of our patients has been so appreciated. We have received so many messages of encouragement. Some of our patients we know so well that consultations by phone are easy and we wonder why we never did them before. Especially for those with mobility or transport difficulties. We did not realise that so many patients would feel more comfortable expressing themselves over the phone. Patients who have not entered the practice in years are often relieved to be able to access our opinion without leaving their homes. Parents worried about their teenagers find a phone call so much easier to arrange than a physical visit. And for some patients, only a visit to the surgery will do…and we often appreciate those consultations as much as the patient despite the extra faff of cleaning and mask wearing. Patients frequently arrive holding a mask awkwardly in their hand or wearing it beneath their chin with mouth and nose exposed. It possibly feels so alien and rude to cover your face but it is the kindest thing you can do when coming to see your doctor or nurse.
Many patients without a medical card have contacted us with symptoms that overlapped with Covid-19 when in reality they had uncontrolled asthma. The absence of a charge for these consultations gave them access to medical care they would not otherwise have. In Ireland 72 people per year die with asthma and it is no surprise. Human nature is such that people will not spend scarce money on a condition they do not recognise as dangerous. Well managed asthma is lifesaving. We are firmly of the opinion that those with asthma should be first in line to receive a medical card.
Children have essentially disappeared from our list of appointments. We see babies for their routine checks, neonatal troubles and vaccinations but the usual creche and school-going children are conspicuous in their absence. We suspect this is part fewer circulating viruses and part reduced pressure on working parents to get a diagnosis and prescription before the next morning’s commute.
One of the most positive changes in the last months is that we can now send prescriptions directly and securely from our software to any participating pharmacist in the country. The barriers to electronic prescribing have fallen away. Our patients are finding this hugely convenient and we no longer do daily battle with our unruly dot matrix printers. Similarly, we can send hospital referrals electronically, smoothing the transition to hospital care if needed. Our difficult decision to seek up-front payments ahead of consultations has been met with a little hesitancy but generally very welcome understanding. This frees up our phone lines and makes for the more fluid running of the practice.
Having made such big changes, it is now abundantly obvious to us that over-crowded doctors’ waiting rooms are fundamentally a terrible idea. Especially during ‘flu season or a pandemic. We have always known this of course but we could not imagine how we could change. Now our patients either wait in their cars, wait outside in our front garden or if there is no one else there before them; in one of our very limited occupancy waiting rooms. Never again will we allow people to squash with their ailments together while they wait to see us.
We have learned so much over the last four transformative months. We are determined to continue to deliver excellent, holistic, comprehensive, patient-centred care to our full spectrum of patients in the months and years to come. Our one hope is that our patients do us the great kindness of wearing a mask when they come to see us.
Dr Sinéad Feeney, June 2020.