FEATURE
GPs in the COVID era The pandemic has hit the community hard and its health lifeline, general practice, has felt its pain.
No single individual or branch of medicine has been untouched by the pandemic and our governments’ responses to it. In general practice, the opening of the telehealth sluice gates has fundamentally changed how GPs are treating patients. It has also affected how many patients they are seeing over the threshold of their surgeries. And while, in the short-term, telehealth has been a safer way of at least triaging patients with flu-like symptoms, it is raising concerns in the GP ranks, given its limitations and the fear the pandemic has created in the community, that there will be a dangerous spike of unmanaged chronic disease symptoms in a few short months. It is a message that now needs to be heard from the chief medical officers and politicians during their daily media briefings. Infectious diseases clinician Dr Nick Coatsworth (who also happens to be a UWA medical graduate) was the first to highlight the issue when he was on media duty over the Easter weekend. He reassured the public that there was an extremely low chance of COVID infection for those requiring a doctor or pathology visit for their chronic conditions. He urged people not to neglect their general health. It is an issue that worries Armadale GP Dr Ramya Raman. “There is a lack of chronic disease
20 | MAY 2020
management right now because patients aren't coming to us for their follow-ups as they normally would. We must brace ourselves for a spike of poorly managed diabetes, COPD, polypharmacy issues in elderly patients, falls, hip fractures to all sorts of cardiovascular health,” she told Medical Forum.
distancing rules but still having a consultation per se, making sure we are recording all the essential vitals, administering the vaccine and monitoring post vaccine administration. The response from our patients has been overwhelmingly positive with this set up,” she said.
“All of which, may, of course, lead to many more people occupying a lot of hospital beds.
“With this current pandemic and the dynamic changes our health system has seen, I think my colleagues would agree that general practice is not going to be the same moving forward.”
“We are grateful for the introduction of telehealth but there are challenges and, I can tell you, that I am certainly missing my face-toface consults with patients.” While fear of COVID-19 keeps some people from visiting their doctor, despite surgeries taking pains to limit numbers in waiting rooms, it is a complex reality facing GPs and practice owners and it may take some time to reel in. With so much media talk, speculation and the all-too-real financial and social impacts of the tough public health measures, the science of treatments and vaccine may be the few things that are able to cut through. However, in the meantime, there must be some semblance of business as usual for general practice. Ramya said the practice for which she works, Skye Medical Armadale, has started outdoor flu vaccination clinics, which are giving her and her colleagues a chance to eyeball some of their patients they hadn’t seen in a while. “We're minimising patient contact and maintaining the social
As a GP with special interest in women’s health, Ramya is aware of the potential impact of family domestic violence (FDV), especially in this current environment of social isolation, job losses, financial stresses and health concerns. It would be a sad reflection of society’s failure to stamp on FDV if it were to be considered a chronic disease, but like mismanaged diabetes in the time of COVID, there is great fear that it is increasing and going unreported. Because of the subtleties of presentation, it is hard to prove that isolation, fear and mounting tensions alleviated by alcohol and substance abuse has caused a spike in FDV incidents in WA. Though some reports from China, during its severe lockdown, indicated that FDV had increased by 30%. “It is a complex area because people don’t tend to come in with FDV as the presenting symptom. Certainly, mental health concerns like anxiety and depression, have spiked in general practice in the past four weeks.” Ramya said.
MEDICAL FORUM | WOMEN 'S HEALTH ISSUE
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Jan Hallam reports
