This is a tale from an exhausted GP as they try and manage the outbreak of COVID-19 in their practice in addition to their normal case load
Saturday 7 March – 8am to 2pm shift
Bleary eyed as usual on an 8am Saturday morning start, I stumble into work, sit down at my desk and sip on the coffee my wonderful colleague has left for me. I glance at the screen and notice the familiar list of 30 patients booked in six hours. Sigh.
My first patient, a delightful 11-year-old, smiles at me as she asks whether she is well enough to go to school camp next week after recovering from fevers, a dry cough and a runny nose. “It’s not coronavirus!” she smiles, her mum mirroring.
“It probably isn’t,” I reply, “ but soon we won’t be able to tell the difference.” Her mum asks how I’m coping with it all.
“Don’t get me started. We have been given 100 masks for our patients. I alone see more than 30 a day.”
My next patient is a man in his 50s I haven’t met. “My daughter thinks I need to start on antidepressants,” he says, before I even get a chance to introduce myself. I steady, have another quick glance at his file and ask him some questions.
He answers: “I don’t know. I don’t feel I’m that bad. My daughter sees you and told me to come talk to you. I’m OK. I just need to get through this.”
I start asking more specific questions. He says, “I just work too much, I have no relationship with my wife. I have no time to do my own thing … The other day a stranger asked how I was and I almost cried.”
As his eyes start welling up with tears, I offer some tissues. “You do sound depressed, and I think you’ve had it for many many years,” I say. “I agree with your daughter that antidepressants will help in your case but we also need to discuss a long-term plan, including a psychologist.”
I call my colleague’s room and ask her to see my next patient so I don’t fall too far behind. I know I can’t fully help this man today but I certainly need more than the 10-minute appointment he booked. I turn back to him and assure him that I am here for him.
Moments later, I get a frantic knock on my door. It’s my colleague who has just picked up the patient I was meant to see. She’s wearing her N95 mask – one of only five for each doctor that the government has so diligently provided our practice.
My heart sinks. This is it … my first real foray onto the frontlines of coronavirus. I’ve talked about this moment with colleagues. I’ve tried to read up on it as best as I can. I know where this is going. But do I actually know what I need to do? I am not prepared for this, I think to myself.
“This is a mess. Put on your mask,” she says. “This should never have gotten past the front door. Public health aren’t picking up their phone! We can’t do this,” she adds. I briefly talk to her patient, a woman in her 30s who has just come back after two weeks in Japan. She has a sniffle. She wants clearance for work because she had this sniffle since before leaving Australia.
We decide that she needs a swab and to self-quarantine for 14 days. Not sure if that was the right answer but it sounded reasonable. We quickly send her on towards the nearest private laboratory collection centre that would test for coronavirus – at least we knew where that was!
My colleague panics as the patient leaves. “I’m a diabetic! Will I get it? I didn’t touch her. I wore a mask. How do I clean the room now?” she asks me.
I honestly don’t know the correct answer but I have to try. Despite being younger, I am the more senior doctor working today. I decide that we will stop using her room and that she will consult instead in the psychologist’s room. I remind the receptionist of the importance of asking everybody when they walk in whether they have a chance of contracting coronavirus. I ask her to print out some more signs for the front door – clearly the existing ones weren’t adequate.
“How we clean the room will be for our future selves to figure out,” I think to myself.
I let out another sigh, put on a smile before returning to my depressed patient. I finish the consult, promising to see him for a long appointment in the coming few days. He thanks me for taking the time out to listen to him.
As I distractedly see my next few patients – a urinary tract infection, a snotty child (“No, she does not need antibiotics for her runny nose”) and teaching stretches to two separate patients with muscular back pain – I try and read up the NSW Health guidelines on how to disinfect the other room. There are pages and pages of information on everything but I don’t find my answer. Where are the flow charts? Where are our clear guidelines? Where do I look now? Do we have a CDC? Do I just google it? Public health won’t answer their phones … what now?
A 26-year-old gentleman comes in next. He is requesting medications for his severe anxiety. He has never been on any before. I know I’m running behind, that again, this will take more than the allotted 10 minutes and the spectre of a “contaminated” room is still at the back of my mind but I resist the temptation to just write a script and let him go. We talk. We find out about each other and we formulate a plan on how to tackle his anxiety.
He walks out happier. If only I could feel the same sense of relief.
I send a quick text to vent to a doctor friend. “Just scrub the surfaces,” he says. Yeah OK … with what? What about the upholstery on the chair? Where are the cleaning materials? I decide to call the practice owner who is working the next day. “I’ll sort it out,” he says. Phew. How will he sort it out? I decide for my sanity not to think about that one.
The next patient comes in for a quick issue, but we get talking about coronavirus. He says that it’s probably all hysteria and that his extended family, including elderly parents, were still going ahead with a Greece trip. I burst his bubble. “You’d likely be fine, and your kids too, but I wouldn’t want my elderly patients potentially being hospitalised overseas without insurance.”
Thankfully there is not much more excitement after this and as 2pm approaches I know the end is near. I inject some steroid into a man’s knee. I counsel someone about their worsening diabetes. My final patients are 2- and 4-year-old siblings. They have minor colds. I do my usual virus spiel, safety net and mention that they should all have flu shots this year. Their mother asks me whether they should all be tested for coronavirus for their colds. “Probably not right now … but who knows what next week’s guidelines will be?”
I settle down in my chair and start my usual post-work routine of writing my notes for the day. I hate the thought of typing while consulting, or making a patient wait for a little longer as I finalise notes between patients, so I have always settled for staying back after work.
I briefly glance at the news and read the Victorian health minister Jenny Mikakos’s comments on Dr Chris Higgins – how she is “flabbergasted” that a doctor with symptoms has returned to work and insinuating that she would work with AHPRA to make sure the message is spread.
More questions swirl around my head. Is this seriously happening? Did she just throw someone under a bus? If my hayfever goes off tomorrow and I have a sniffle, do I further cripple the frontlines by self-quarantining for two weeks? Did she really say that GP practices are “well equipped”? Can I really be reported to AHPRA for trying to do the right thing?
I am absolutely seething by now. I finish my notes much slower than usual, leaving the now empty medical centre at close to 4pm.
I text my girlfriend, telling her I’ll be late to a family dinner and get in my car. I am exhausted. My mind is spent.
I am happy to be the frontline in the government’s war with coronavirus but I am being sent out there with no armour, no weapons and no leadership. I am 30 years old, a fully qualified GP, presumably diligent, passionate about primary care and still at the early stages of my career. For the first time in a long, long time I question my choice to become a doctor.
I am burnt out.
Some days I feel like I sacrifice my time, sanity and energy into looking after other people. But who will look after me?
This story was originally published on The Guardian Australia. You can read the original article here.
