Remote caring causes anxiety
In a very short amount of time, our world seems to have been turned on its head. Less than three months ago, my family and I were travelling home after a trip to visit relatives in the United Kingdom, and marvelling at the ease with which we could cross the globe.
Now, that feels like an impossible dream and, in fact, even a walk down to our local pub to hang out with friends seems unrealistic in the near future.
We’re not alone. More than a third of the world’s population is living under some sort of lockdown, and perhaps there is reassurance in that.
Something that has really struck me as I have watched our nation, and others, cope with this crisis, is how adaptable we humans can be – learning to work from home, have our kids in the same space with us 24/7, restrict our hobbies and activities to things we can do within our neighbourhoods, leave the car in the garage and travel by foot, and cook with what’s in the pantry and fridge.
I am sure that on one level, once we can leave the awfulness of the disease itself to the side for a bit, there is a lot of good that will come from this forced adaptability, and maybe we will instil some good habits that will remain with us long after this outbreak has waned.
As GPs, my colleagues and I have had to adapt to this changing landscape. In the space of a few days, we have had to move more than threequarters of our consulting to being conducted ‘‘remotely’’ – this means using either phone or video-technology to connect with patients who we would usually see face-to-face.
This probably sounds simpler than it is: of course in our pre-Covid-19 working lives, we frequently called patients, but usually this would be done to discuss something quick, and not as a means of assessing someone’s medical concerns.
There are some situations where we are suggesting people do come in to the practice, for example, if we think someone is acutely unwell and an examination would aid in the diagnosis – think of a suspected appendicitis, or someone with a nasty chest infection. But, when making that decision, we are having to carefully weigh up the benefits (making the correct diagnosis) against the potential risks (the possibility of exposing either the health provider team or the patient to coronavirus). And when they do come in, patients are greeted by a team wearing masks, gloves and protective eyewear – not the most welcoming sight.
For the patients we consult on the phone, having to restrict our clinical assessment to what can be gleaned via a short telephone call, without being able to actually see and connect with the person sitting in front of you, has introduced a level of anxiety that I am finding hard to come to terms with, and I’m sure my colleagues are, too.
I am finding it most difficult when it comes to my patients who are suffering with their mental health.
A large part of that work involves reading the cues from the patient, picking up the eye contact, or lack of it, their body language, the animation with which they talk to you – all of which is hard to do unless you are there with them.
This new way of working leaves a residual level of clinical uncertainty that is much higher than usual – sitting with this uncertainty, as uncomfortable as it feels, is something I suspect all doctors are going to have to learn to do over the coming weeks.
There are also some very practical concerns for GPs, as we come to terms with how long this ‘‘shutdown’’ may go on for.
Supplies of certain medications are becoming scarce, so we are having to think through how and when we can safely move patients to other, more available alternatives.
What do we do about screening programmes – for example, cervical smear testing? Obviously, they are not possible to do remotely, and for most people not an urgent test – but when will we be back to ‘‘business as usual’’ and how will we deal with the backlog of this kind of work when we are? How do we cope financially?
General practice clinics rely partially on a government subsidy, which means that the true cost of primary healthcare isn’t ever passed on to our patients; the remainder of our funding comes from those patients who do pay for visits – that part of our income stream has almost entirely dried up since we introduced ‘‘remote consulting’’, yet the costs for running clinics remain the same.
This has resulted in some practices reducing their workforce, cutting hours and cancelling locum cover for leave, putting an extra strain on teams already under significant pressure.
Added to this is the ‘‘personal’’ toll that Covid-19 will have on our workforce, much as it will on other essential work teams.
I can’t speak for all my colleagues, but I know I am fearful at times. Fearful of being exposed to coronavirus and becoming unwell. Fearful as to how this could impact on my partner, children, and wider wha¯ nau, especially if I am at work and can’t support them. Fearful of having to self-isolate, away from them, if I do get sick.
And fearful about what the future holds – for the community I hold dear, and the profession I love.