The virtual doctor will see you now ...
The Covid-19 crisis means GPs are under huge pressure but it has also brought key reforms, reports Wayne O’Connor
IT seems out of kilter that in the midst of a health emergency, waiting rooms in GP surgeries across the country have been lying idle for three months. No magazines, no crying children, no suspicious gaze when a person coughs or sneezes.
“To be honest, people have been scared to come in because of Covid-19,” Dr Eamonn Shanahan, a GP in Kerry, admits.
“There is reluctance. I was out walking one evening and there were two brothers I met, both with significant health problems. One of them was due to be admitted to hospital for a heart procedure. No way would he do it. His expression was, ‘I’d sooner die of my heart than die of Covid’.”
Shanahan’s practice in Farranfore, Co Kerry, remained busy throughout the crisis but not because patients were visiting him. Covid-19 has changed how it operates. Consultations mainly happen on the telephone or online now, with patients triaged virtually before being brought in.
Social distancing means all four practice partners and its trainee doctor cannot be on site at the same time. Often a patient may end up speaking to a doctor working from their living room or kitchen, but they wouldn’t know this.
Last Wednesday, patients got in touch with a typically eclectic mix of issues. There was one with tonsillitis and another with bad sunburn. Some were brought in for blood to be taken. A few patients needed renewed prescriptions or painkillers for discomfort. More patients needed sick certs for work or others who raised concern about a sick loved one.
“We are treating as many people as ever, but 95pc of things are being sorted out over the phone now,” he said.
One patient presented with a suspicious lump. Shanahan says, while people seem comfortable contacting the doctor about routine matters, there is a reluctance to get in touch about ailments that may require a follow-up hospital visit.
This tallies with concern nationally about a drop-off in patients presenting with chest pain, suspicious lumps and other acute matters during the crisis. Shanahan says this will pose issues going forward. He is also especially worried about the mental health needs of patients.
“There is a tsunami coming at us because this [lockdown] is a nightmare for people with mental health issues,” he says.
“You don’t need to be a psychologist or psychiatrist to know this impacts people across the spectrum. Preschoolers — in many cases, this is like a summer holiday for them — but older children, six to 10-year-olds, are finding they are losing out on friends, the craic and playing sport.
“Moving on to teenagers, who may have their own anxieties already, they now have other pressures and young adults are in college or coming out of it at the worst time ever.
“You have people in their 20s, 30s, 40s and right through who have financial worries and concerns over being out of work because of Covid-19 and older people who have health concerns.
“One of the worries we have is there are a significant amount of people with mental health problems,” he adds.
At another practice, 300km away in Dublin, there is also apprehension that the future will bring another form of deluge. Dr Conor O’Kelly, at Rialto Medical, says his practice has stayed open and coped well throughout the crisis.
He admits an early surge of suspected Covid-19 cases was overwhelming. Many of the patients he treats, because of their economic circumstances, live in cramped or confined conditions where the virus can spread rapidly. Demand
for testing was high in March and April and a number of patients were hospitalised with the illness. Some died because of complications with underlying illnesses.
His practice adapted and the majority of consultations are done online or using video software. Patients are called in to the practice, if necessary, but nobody is being left without vital care.
However, he has worries. “We are seeing people with acute stuff but a large part
of what we normally do is chronic medicine. That means managing diabetes, heart problems, lung problems.
“That means routinely checking pulses, checking blood pressure, listening to chests but it is something we are not doing at the moment.
“We need to look at how we start doing that because it is those chronic diseases that, if kept under control, keep people out of hospital.
“Demand for such work is going to ramp up as we head towards autumn, especially as cocooners see the need to get their routine check-ups.
“We have not done any cervical smears for 12 weeks. That is concerning for us. We hope those types of things will be running again soon. Going forward, we need to get back to doing those preventative things such as screening and staying on top of the chronic diseases in a safe way.”
He does see positives emerging from the crisis too.
“There has been a revolution in GP care and so much more of it is being done online now or over the phone through telemedicine.
“There are things that patients will still have to come in for, but it is possible to do so much more remotely now. Covid-19 has forced us to get comfortable with this very quickly and it seems to be working.”
Dr Lucia Gannon, who runs a rural practice with her husband Dr Liam Meagher in Killenaule, Co Tipperary, agrees.
“We are quite busy, with nurses’ and doctors’ appointments booked up a week in advance and we have probably doubled the workload to cope because all our patients are triaged on the phone before they come. Anyone who comes in has been given a video or telephone consultation first.
“There are lots of benefits but it is not for everybody and for everything. Nobody comes in without having a chat first but nobody is left stuck.”
Further changes are coming in the future, too. She plans to erect a canopy outside the practice where anyone who may present with Covid-19 symptoms can be treated.
She agrees that some of the reforms Covid-19 has forced on the sector are positive and should be here to stay.
However, all three doctors insist they can only do their jobs if patients keep coming to them. Their waiting rooms are shut but a doctor will see you, they insist.
O’Kelly explains: “Probably the most efficient way to operate was to have packed waiting rooms and turn people over every 10, 15 or 20 minutes. Those days are clearly gone. Restructuring might mean having phased starts with staff coming in earlier or later.
“Telemedicine is here to stay, even if we had a vaccine tomorrow, because easily 50pc of our work could be done with telemedicine and 50pc face to face. But we are open. We’re still treating people.”