7 July 2021

A day in the covid clinic life of a GP registrar

Comment covid vaccine

Phew.

What a week …

And it’s only Wednesday.

Apart from the fact that my household is now suffering from a severe shortage of toilet paper and the fact that my Vitamin D deficiency is only likely to worsen over the next three days, this past week can best be described as confusing and at worst, downright infuriating.

With large swathes of Australia in lockdown (you’d think we were in the middle of a pandemic or something), I thought I would share what it is like working as a registrar in a GP clinic, in the middle of a lockdown with a very fluid, seat-of-your-pants vaccination rollout.

The day begins with me entering clinic and donning the currently trending, on-fleek, blue disposable mask and lamenting the fact that I missed my chance for an early retirement by investing in a mask-producing company at the beginning of 2020.

I spend the next 10 minutes trying to fit my mask so I don’t suffer from glass-fog for the rest of the day (and look like a complete numpty while giving health advice to my patients).

You know the look

The next step is to look at my appointment book and see how many people have booked in to see me to “request a mask exemption”.

Only three today. Dream.

FYI, unless you literally CANNOT breathe with a mask on (i.e. severe asthma, severe lung disease), the chances of you getting an exemption from me are quite slim. I will not give out an exemption because you had “pneumonia 10 years ago” (all the more reason to wear a mask, my friend) or because you are a “smoker” (yes, no joke, I have had this request, also please stop smoking) or because you “want to go travelling and not pay a fine” (sorry buddy, stay at home, watch Netflix like the rest of Australia).

After my appointment book has given me early onset hypertension and an eye twitch that won’t go away, I practice some self-care and look away from my screen.

I focus my attention to the pile of pathology request forms sitting innocently by the printer to ensure the pile is well stocked. I’ll have to fax at least a handful of these down to our nearest covid testing clinic after seeing people with respiratory symptoms over the next few hours.

After seeing the first few patients for non-covid-related presentations, I have my first break and tune into the latest press conference on ABC News on my phone. I’ve come to think of this 5 minute break as vital medical education necessary to survive the day in GP land. I mean, what if the vaccination recommendations change midway through a day and I was caught unaware? That would look bad, wouldn’t it …

Having completed my daily CPD via ABC news, I get ready to see the next few patients who all have respiratory symptoms. In anticipation, I warm up the printer and send it to work to spit out some “Novel Coronavirus PCR” pathology request forms. I think to myself that the “novelty” of this virus has definitely worn off. 

I refit my mask, put on a face-shield and don a pair disposable gloves to ensure that a respiratory droplet couldn’t get inside me if it had a PhD and a microscopic chainsaw.

I waltz down to the back carpark (where we conduct all of our respiratory consultations) and proceed to practice clinical care (#medicine). 

Every consultation ends with a spiel I have now memorised (covid-19 = bad, if you’ve got even the slightest tickle in the throat, you require a covid test). Patients usually respond to this request with anything from complete acceptance to begrudging compliance to a barrage of profanities and eye-rolls followed by car doors slamming shut.

Then it’s back upstairs to carefully remove my PPE and sanitise the equipment before the next carpark consultation.

After my daily cardio of running up and down the stairs is complete, I sit down for a quick lunch before getting ready for my afternoon covid vaccination clinic. Like most GP clinics, we only stock the AstraZeneca (or AZ) vaccination.

Before the clinic starts, I double and triple check the latest ATAGI advice.

A distant three weeks ago, I was telling those age 50 that they were safe to receive the AstraZeneca vaccination.

Then I was telling those only aged 60 or above that they were recommended to receive the vaccination.

Last week, it was announced that anyone can have the AstraZeneca vaccination.

Almost immediately after that it was announced that for those in Queensland (where I live and work), the AstraZeneca vaccination was no longer recommended for those under the age of 40.

In summary, I’ve had to ask myself multiple times this week:

“What the flippin’ hell is going on?”

The clinic is busy.

I’ve got less than 5 minutes with each patient to ensure they meet eligibility criteria, have a valid consent, are well today, have an opportunity to ask any last minute questions, vaccinated them, give them post-vaccine advice and then document all of the above.

If they are receiving their first dose, I always ask patients if they’ve ever suffered from heparin-induced thrombocytopenia (HIIT) or cavernous sinus venous thrombosis (CSVT) which are two contraindications to receiving the vaccination. They always look at me like I’ve just got off a chartered jet from Mars whenever I mention those two conditions.

Good. If they don’t sound familiar, you’ve definitely never had them before. We can proceed.

Final Thoughts 

After two-and-a-half hours of repeating the above, my brain is fried and ready for home, only to come back and do it all again tomorrow.

That’s it folks. That’s a day in the life of a general practice registrar during a pandemic.

If you thought my day in primary care was hard, please wish me luck for my next (arguably more challenging) endeavour.

The search for toilet paper.

Dr Nisha Nangrani is a Queensland GP registrar. This piece was originally published at doctornisha.com.au.

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