As GPs across the country spend more and more time speaking to patients concerned about having caught coronavirus, concerns have been raised that some patients with acute or chronic illnesses who regularly need to see their doctors are not doing so for fear of catching Covid-19.
At the end of March both the Irish College of General Practitioners and the HSE reminded the public that GPs were still seeing patients – albeit with infection-control measures in place.
The medical director of the Irish College of General Practitioners, Dr Tony Cox, said patients delaying consultations with their GP may subsequently lead to a more serious clinical issue.
Dr Nick Breen, a Greystones GP and lecturer in general practice at University College Dublin, is keenly aware that some patients who are staying away from the practice need to see their doctor.
“There is a huge unmet need out there. It’s difficult. We have to try to make sure that we don’t ‘not see’ the patients that we should see, and give appropriate advice to the patients that we shouldn’t see.
“People still get heart attacks, still get appendicitis, still develop acute diabetes, still get meningitis. And it’s likely that some people who should be ringing us, and who should be going to hospital, aren’t doing so due to fear of Covid; a not unreasonable fear, let’s face it,” says Dr Breen.
He adds that about 25 per cent of patients usually treated at the practice come for psychological and psychiatric issues. “We are simply not seeing these patients. And yet their need for care is still there.”
Symptoms
Like GP practices across Ireland, the Greystones Harbour Practice has its doors locked and over 90 per cent of consultations are on the phone or via video link. And most patients calling the practice are calling about symptoms they suspect are due to Covid-19. All patients are screened for Covid-19 symptoms first, before discussing any other heath concerns. At time of writing GPs can order a test for Covid-19 but they can't carry out the test themselves.
Dr Breen says some patients are still attending the surgery – but only after phoning first and making an appointment.
There are no patients in the waiting room. Patients wait in their cars, and are brought in individually once the previous patient has left.
“One of us is assigned daily to run the respiratory clinic, morning and afternoon. We will see patients who need to be seen with respiratory symptoms wearing full personal protective equipment.
“Patients without respiratory symptoms are seen by another doctor, who will wear mask and gloves. We are still running vaccination clinics (children need their vaccines) but at a specific time, and with no one else on the same floor.”
Dr Breen predicts there will continue to be fewer patients in surgery until community spread of coronavirus leaves people with moderate to early severe illness in their homes.
“Then I’m not really sure how we, as GPs, and society as a whole, will cope. Already we are getting some guidance from palliative care consultants as we are going to inevitably have to look after patients at home who are going to die from this illness at home.
“I have patients who I know would refuse to go into hospital to be ventilated- even if there were enough ventilators. It is heartbreaking,” says Dr Breen.
He believes the situation will get much worse in the next four to six week in Ireland.
“There will be difficult choices, difficult decisions and huge ethical issues for doctors and society. And there will be personal difficulties for us, our families and for all healthcare workers.”
Regular exercise
Dr Nuala O’Connor, the Irish College of General Practitioners lead on Covid-19, says that it is important for GPs to look after their own health during the pandemic.
“Even though GPs are working hard it is still important to try to take some time for ourselves, to get out and take some regular exercise, to try to eat healthily,” she says.
With her husband also in the medical profession, Dr O’Connor says she is grateful to her three adult children (studying for university exams at home) who are looking after their hard-working parents.
“They are totally minding us, and we are coming home to lovely home-cooked meals. All the old baking books have been taken out as they make their favourites from childhood.”
Dr O’Connor says there are plans to have community Covid-19 assessment hubs operating around the country.
“The plan is to have designated general practitioners assessing Covid-19 positive patients who start to become unwell. This will allow normal general practice surgeries to see patients with non-Covid-related illness.”
