Medical centres around the country have been instructed to reduce the number of in-person consultations they conduct by 70%. Toby Hills, a doctor based in Porirua, explains the rationale behind this and what the public can do to support our primary care system.
Even during a pandemic, humans still get sick for other reasons. Appendixes still try to burst. People grow understandably depressed and anxious. Mysterious scaly rashes still appear on our earlobes and eventually vanish for no reason at all. Kidneys still get cancer, brains still get Alzheimer’s and the colon still gets threadworms. Nobody should really get chlamydia during a nationwide lockdown, but some will probably still get chlamydia.
Chlamydia finds a way.
The trouble is that community medical centres are where the most vulnerable in society gather. Co-workers with serious heart and lung diseases. Friends with diabetes or frail immune systems. Precious kaumātua and kuia and other elderly relatives. Catching Covid-19, for the 10% of the population in these vulnerable categories, could be catastrophic. In New Zealand we know that this 10 percent is disproportionately composed of Māori and Pasifika people who are unfairly disadvantaged in the health system already. Aotearoa has a duty to protect our vulnerable people.
In places badly hit by Covid-19, healthcare workers ended up becoming the source of Covid-19 infection for many vulnerable people. This is why, during the weekend, the Royal New Zealand College of General Practitioners instructed every medical centre in the country to reduce the number of in-person consultations (that is, you and your doctor or nurse sitting in the same room) by 70%.
The goal is not to eliminate in-person doctor visits entirely, which would frankly be a terrible plan. GPs still need to listen to the phlegm clattering around in particular windpipes. Injuries need to be fixed. Nurses still need to squirt tiny bits of dead influenza virus into the shoulders of elderly and pregnant people and people with certain chronic health conditions. This is why the 70% figure was chosen.
However, this remains an immense change in the way we deliver healthcare that we have been forced to implement over only a handful of days. There have been teething problems. Some patients phoned on Monday and were told to expect a call back from a nurse or doctor that day, which did not come until Wednesday. Still others have had non-urgent appointments cancelled.
Part of the problem, is that many of the requests being made by the public of their medical centres are unnecessary or inappropriate, which takes time away that we could be using to deal with people that need our support
On behalf of all medical centres in the country I can tell you: We know you are frustrated, and we are sorry. We are doing our very best, but to help us along there are a bunch of ways the public can help smooth this transition and take a little of the pressure off New Zealand’s medical centres.
Do call your medical centre for advice. Please do not turn up without letting anybody know you are coming in advance. This puts yourself and others at risk.
Do call 111 in an emergency as you usually would.
Do arrange to have a flu vaccine if you are eligible, but please be understanding if there are delays and temporary shortages.
Do use internet services whenever possible to communicate and try to limit phone calls. We are having trouble contacting our patients while the mobile networks are overloaded.
Do not force your employees to provide off-work certificates for unwellness. If a patient tells me they have diarrhoea I do not make them demonstrate it. If they can lie to you they can lie to me also. This consumes valuable time and it puts your employees, healthcare workers and the public at risk of infection.
Do not force your employees (if they are part of an essential service that will not down-tools) to get certificates to say they are ok to come to work again after they have been self-isolating for 14 days after travelling and have not had symptoms. This is a waste of everyone’s time.
Do not force your employees to provide a certificate stating they have a chronic health condition and should not be working. There is a theme here.
Do not request repeat prescriptions too early or ask to stockpile medicine for longer than the standard three months. Pharmacies are running into exactly the same problems as the supermarkets, but instead of running out of toilet paper they are running out of life-saving drugs that allow people to breathe properly.
Do not request poorly studied cocktails of drugs like azithromycin and hydroxychloroquine for Covid-19. Not only is there minimal evidence that this combination is effective, it might just cause a fatal heart arrhythmia. Even worse is that it deprives people with debilitating conditions of the drugs they need to function day-to-day.
Do not request “rescue packs” unless you are already prescribed them regularly. These are combinations of antibiotics and steroid tablets that are occasionally used to treat flare ups of some lung problems. It is possible steroids may worsen Covid-19 and antibiotics don’t do squat for viruses anyway. Always speak to a health professional before using any prescription medicines. This is particularly egregious if you don’t even have underlying lung disease.
Do not steal hand-gel dispensers and masks. You know who you are, you actual hobgoblin.
The way you “see” your doctor or nurse has changed, but not as drastically as you might imagine.
A large chunk of the work we do does not require you to be within spitting distance. Most of the information we need to treat chronic asthma is symptom-based: How often do you wheeze, splutter and use a puffer, and when? You could show us how you use your inhalers on video and we could correct your technique if needed. Most people with diabetes should have a physical examination at least yearly, but fine tuning of medications or discussing lifestyle changes can take place over the phone and is primarily guided by blood-tests. When it comes to recurring medical certificates for Work and Income and ACC a discussion over the phone is usually adequate.
Generally, what will happen is that whenever a person requests an appointment they will be phoned by a doctor or nurse who will work-out, in conjunction with the patient, whether they need to be seen in person or whether a telephone or video consultation would be suitable. The flow of bodies through a medical practice will also change. Waiting rooms will close. People will often be brought directly from outside or from their cars into consultation rooms. Suspected Covid-19 cases will often be directed to specialised clinics for this purpose. Patients that have infectious or respiratory symptoms, might be assessed in their cars when possible and not brought inside at all.
Can we be 100%t sure that the healthcare we provide will not be impaired in some way? We cannot. It is likely that stable, chronic medical conditions will be monitored less closely and less regularly. It is possible that some serious diagnoses are missed that would not be missed if the patient was in the same room. We have to remember the reason we are doing this and that if we were not, the consequences would be so much worse.
Just because we will not be seeing you in person as often does not mean your doctors and nurses and other healthcare providers have stopped caring about keeping you well. It’s what matters most to us. It’s the reason we do our jobs. Please bear with us as we adjust to these changes and do everything we can to deliver healthcare at a standard that we are proud of.
But yes, we will still probably be running rather late.