COVID-19 through the eyes of a British doctor
Dr Richard Johnson is a British GP currently practicing in South West England in both ‘hot clinics’ where he’s on the frontline, treating patients with possible and confirmed COVID-19, and also ‘cold clinics’ where it’s business as usual. He shares with us some of his recent experiences working in one of the worst hit countries during this current global pandemic.
With the number of UK hospital deaths due to COVID-19 now over 20,000, how are the normally stoic and pragmatic British people coping? What will the long-term impact be on society and more specifically the role of healthcare professionals?
It will depend on how long this crisis lasts. In the short term, people have had time to reflect more on their lives and community has become stronger. I’ve also seen an increasing respect for healthcare professionals such as doctors, where this was previously lacking. The question is really whether these impacts will last or whether we will revert back to how things were.
How are you personally coping with the pandemic? Do you have any friends or family who have been directly affected by the virus?
I have friends and colleagues who have been infected and I was even potentially infected way back in January. Thankfully, I don’t know anyone personally who has died from it as yet. I mostly struggle with not seeing my friends and family, or being able to travel abroad. I had planned to move to Australia this year which was obviously cancelled due to the crisis. In one way, we’re lucky as key workers as we’re able to get up and go to work each day, keeping a sense of routine and normality.
How scared or uncertain are you each day when you make your way to work?
To begin with I was scared, but now we’ve developed protocols and sourced adequate PPE, I’m more used to the situation. The challenge will be to maintain these precautions to make sure I’m not infected down the track.
Of the patients who have presented to you with COVID-19 symptoms, how many have then been diagnosed with the virus?
Not many. Currently only patients admitted to hospital are tested and I’ve had a handful of those. Most have done well. A few have died. We are diagnosing most cases clinically and without testing.
Telehealth consults the new normal
What part is telehealth now playing in general practice?
In general practice, telehealth is now the main way we’re conducting our consultations. For example, just today I completed eight video and 36 phone consultations. Patients are emailing us photos also. I only saw two patients face-to-face in our clinic today.
Do you think this form of virtual care will now gain momentum in the UK even after COVID-19?
Yes, I do. Although some things will revert back to how they were such as defensive practice and patient demand, some new things will stay. Video consulting will really take off as companies realise the commercial opportunity and doctors become more used to it.
One of the tragedies of COVID-19 is that people with the disease are dying alone. How are health workers coping with this? How do you make sure those people have ‘good’ deaths in an environment where family members aren’t there?
This is a big challenge. In the UK, we don’t have enough district nursing staff to provide the excellent palliative care required, especially out of hours. And COVID-19 is a new palliative challenge with fast changing symptoms and high opioid requirements. We do have access to hospice beds which is helping. But it is immensely sad that relatives are often not able to be involved. There’s a 24-hour hotline to palliative experts for doctors to call which has proved to be really helpful.
Are you and your colleagues satisfied with the measures the NHS is taking to support its health professionals? Can you share some of the initiatives that are making a difference?
By and large yes. We’re able to access testing and psychological support. The NHS also moved quickly to hold routine matters and has vastly increased staffing levels. Pointless paperwork has been mostly stopped. I hope some of these initiatives stay after the crisis. The big downside I’ve noticed is that locum staff have not been supported, in as much as they still won’t get a pension lump sum should they die. This has reduced the potential workforce numbers and could be easily rectified by the NHS.
The UK is gearing up to use the blood of COVID-19 survivors to treat hospital patients with the disease. Can you shed some light on how this will work?
This is the principle of convalescent plasma. It’s quite an old technique and was used with reasonable effect for Ebola. My brother is actually working on this in Germany where they’re trialling this technique in his unit. The NHS is currently asking for volunteers who have had COVID-19 to donate blood.
Locuming in New Zealand
Thinking back to 2016 when you worked in Queenstown in New Zealand as a locum what was your experience like? And what are the differences between working in the UK and New Zealand?
I loved Queenstown and I also worked previously in Auckland and Te Kuiti. In New Zealand I felt liberated by the relative lack of paperwork, much less defensive practice and relative autonomy. The work life balance was better. The NHS is more efficient and coherent however in its guidelines and access to secondary care.
What advice would you give to other British doctors considering a locum in New Zealand?
Do it. You’ll get used to the experience very quickly.
Thank you so much for sharing your insights with us Richard.
Hearing first hand from doctors on the frontline in countries hit hardest by the COVID-19 is both saddening and inspiring. Whilst we are a long way from our friends and colleagues in the Northern Hemisphere, we are all connected in our commitment to providing healthcare to our global communities.
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