Patients warned on ‘sitting out’ ailments not linked to Covid-19

Doctors have cautioned patients against “sitting out” non Covid-19-related health complaints during the crisis but say a large backlog is likely in providing treatment as the system attempts to return to normal.

Endocrinologist Prof Donal O’Shea says a lot of his clinics have been successfully moved away from face-to-face and on to telehealth platforms.

“We’re very surprised at how positive an experience it has been to date. Whatever about seeing follow-up patients, we thought it would be very difficult to see new patients with just phone or visual support. But in our specialty this is proving not to be the case, and distance consultation are proving to be very effective 80 per cent of the time.”

However, the situation is different for surgery across a range of medical disciplines, “where no phone or visual will do for you”.

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He foresees “massive backlogs and build-up” of lists in areas such as gastro-intestinal medicine, minor surgery and elective procedures such as endoscopy, due to the concerns over infection control.

With the system remaining in “paralysis mode” for the past two months during the crisis, Dr O’Shea says his biggest concern is that so many patients are “sitting it out” and not seeking any medical advice for ailments from primary care or in hospital.

“Most advances in medical care in the last 30 years are built on earlier diagnosis and earlier intervention. The later a person presents in any disease, the worse the outcome. So the clear worry is that patients who may have a chronic disease, such as diabetes or cancer, are not presenting to primary care.”

Dr O’Shea, who works at St Vincent’s University hospital, says emergency department attendances last week showed “a bit of a comeback”, and Friday was “a normal day”, numbers wise. Today’s attendances will be “interesting”, he says, because the day after a bank holiday weekend is normally busy.

The HSE is now planning to ramp up non Covid-19 activity in hospitals once again but says capacity will have to be restricted to about 80 per cent to allow for infection control.

Dr O’Shea says “this will be a tough one to balance” and is likely to involve “keeping a lot of patients out of hospital”.

“When you’re in an environment where you actively want people to come to hospital and seek help, but at the same time you’re saying we can only operate at 80 per cent capacity, that’s a mismatch, it’s part of the contradictions you get in the middle of this situation.

“There’s going to be a big backlog of work,” says respiratory consultant JJ Gilmartin. “This has affected cancer, COPD [chronic obstructive pulmonary disease], sleep medicine, everything, and pathways are going to have to be found to pick up again on all the non Covid-19 cases.”

Many of the patients Dr Gilmartin sees at Galway University Hospitals are developing COPD, which often starts off with a cough and progresses to breathlessness, by which time the patient may have lost half their lung function.

While the disease is easy to diagnose, through a simple spirometry test, the earlier this happens the better for management of the condition.

What is the impact on patients?

However, the tests have been cancelled along with so much other hospital work and Dr Gilmartin says he has been unable to see new referrals for several months.

“You can’t deal with a new patient on a phone call, but genuinely terrified of coming into the clinics. These people were cocooning before the word was known.”

Existing patients have missed out on pulmonary rehab clinics as well as support group activity and the chance to network these provide.

“Some feel that we must be awful busy in the hospitals and they don’t want to bother us. But if they don’t act promptly when they suffer a flare-up they’ll get worst and may end up with prolonged hospitalisation.”

One doctor who himself required urgent medical attention in recent months admits “I really didn’t want to go into hospital” because of his fears over infection. “Things have improved a lot since this crisis started, in terms of awareness of the risk and the protection provided to patients and staff,” he says.