Thoughs from a GP on a Pandemic
These are thoughts from my father on 26th Jan
Pandemic thoughts from the front line
I am a GP aged 64 who has worked for 35 years in the NHS. I believe we need a bottom up approach if there is a pandemic threat and I will concentrate on suggested measures to consider at practice level. I hope this will open up a conversation and sharing of ideas.
Staff. in Wuhan the weak spot seems to be the health service which has been seen to be collapsing after only a couple of weeks. There are videos on line of exhausted demoralised staff working themselves into a state of collapse with film of doctors falling to the ground. The government has had to fly in an extra 1000 clinicians to help out. This is possible in the early stages of an infection but at the rate they are having to quarantine (currently 56m) there soon won’t be any spare clinicians. It would be wise to work hard to prevent exhaustion of staff by any means possible. They will soon become exhausted with the added work load and anxiety of patients.
Visits We will tell patients to stay at home if they have a fever. However many will have other additional worries like secondary bronchitis, confusion gut problems etc. They may need a visit. Who will do this? I would suggest one partner per practice draws the short straw and confines themself to dealing with feverish patients.
Personally I would rather get the infection early in a pandemic; hopefully get over it, and then be able to work without restrictions or fear. Looking at the hazmat suits that clinicians have had to wear for Ebola or the corona virus it’s clear that working in them is exhausting. To do a long day in such a suit and then again all week would I assume lower ones immunity sufficiently to put one at increased risk of serious illness. That poor doctor aged 62 who died after treating the initial cases is a warning of the risks. A second doctor aged 51 died on the same day with acute MI. This suggests the stress may have been severe to bring on the coronary.
The medical workforce would struggle so I think the government should plan to relax the rules over who can practice. For instance they should encourage retired doctors to be allowed to work without worrying about indemnity, appraisal or the mandatory training. CQC and QOF should be suspended with the QOF fees being carried over from the previous year’s attainment. There is a large workforce out there that could be mobilised and help enormously.
Hospitals would very soon come to a crisis. Our local DGH had to declare an ‘opal’ emergency a few weeks ago with 160 patients awaiting a bed. This was without any flu epidemic or freezing weather. I guess the hospital would stop all non-essential work like orthopaedics, routine cardiology and gastroenterology, physio and outpatient follow ups and monitoring of non-critical patients. Whether these doctors and nurses would be prepared to work on fever wards however is another matter. In the film ‘contagion’ the nurses went on strike as the protocols for such work were not sorted out. I’m afraid we would all be working without much protocol guidance. It would be crisis guidance which is why it pays to think about it in advance.
Drugs might become scarce if there is economic disruption and people vote or are told to stay at home. If schools are shut parents won’t be able to go to work. Many drugs would no longer be available and it behoves us to decide in advance which ones we and the patients need to worry about. These could readily be stopped for months and restarted when normality returns. Such drugs would include statins, bone protective agents, vitamins and minerals, many psychiatric drugs for mild anxiety or depression or insomnia. levothyroxine. Our staff would need such a list to be able to reassured anxious patients unable to get their normal prescription. Other drugs would be essential and a list of them would include insulins, antitbiotics, antipsychotics. Anticoagulants and antihypertensives are a grey area that would need individual decisions. This is all relevant as it may come to non clinical staff to sort prescriptions and triage the simple decisions such as re-prescribing repeat medications. EPS (electronic prescribing) will help, hopefully, to automate and reduce the workload. People will try to avoid the surgery as a dangerous place of infection and if we can steer them to chemists instead that will help.
We see a lot of trivia and the worried well. We would need to deal with them robustly. I would plan a code of TW (time waster) and after two entries of this would refuse any further appointments saving them for genuine patients. In non-crisis times this would soon land us before the GMC/NHSE with a complaint. In crisis there would have to be a general amnesty for clinicians to spare them complaints when working under such stress. It would be nice to be able to tackle these time wasters without fear of redress. Additionally CQC, appraisals and mandatory training should be waived for that year. Finances should be based on previous years income and no detailed paper work expected of the poor beleaguered practice management. These measures would free up enough time to allow us to deal with the urgent workload adequately and perhaps without collapsing primary care. I assume secondary care would collapse and we are the advocates and helpers of our own patients and I personally feel a duty to look after them even if my pay masters and bosses at NHSE fall apart. and don’t offer much support.
Security Patients can become aggressive when anxious. This may cause scenes at reception. We may need to support front of house and I doubt the police will be able to help. We might have more luck asking for volunteer help from our own patients. Many will be stuck at home unable to work and in my experience there is enough altruism out there to make it worth asking for help.
Isolation One of the main social issues currently is loneliness. Many live alone and don’t go out and interact much with society so no one else apart from perhaps us knows their situation. They would be very vulnerable especially to the corona virus that makes people ill for a couple of weeks. Modern society has little sense of community and its not helped by social media where people can do all their socialising on line. Hopefully this won’t go down and will be useful for people calling for help. The best defence in a time of crisis is however a good sense of community with people being aware of vulnerable neighbours. If areas of maybe a few hundred people, say an estate or a few roads were put together as a ‘community’ and a few individuals could be encouraged to mobilise their neighbours to organise, this would make a huge difference. Surgeries and churches could help with this but it would be down to individual areas to work out how much they could do.
Recovery The most valuable people in an epidemic are those who have recovered. They no longer have to be careful or fearful. They could play a disproportionately helpful role if they can be mobilised. I doubt they would be prepared to be co-opted by local authorities or government as the job would seem too huge and distant. It’s much better to be asked by the local surgery to help locally. Again it helps being organised into local communities.
Edited for readability copying it before messed it up
[link] [comments] https://ift.tt/eA8V8J
from The United Kingdom of Great Britain and Northern Ireland https://ift.tt/3chDVay
via
Comments
Post a Comment