PROVIDING primary care during the COVID-19 pandemic has resulted in unexpected challenges for many doctors. While Member queries to MDA National’s Medico-legal Advisory Services can follow similar themes, there is no “one size fits all” when practices and practitioners pivot to meet these unique challenges. Issues are often specific to each individual doctor, and those outside the primary care field – patients, the media, the government and even other non-primary care providers – sometimes struggle to appreciate the challenges. This can lead to a lack of understanding when medical practices are required to implement different policies in the face of the same pandemic.
Each doctor’s experience of COVID-19 can vary considerably depending upon a number of factors, including location. Some general practitioners have been in the middle of a virus hotspot, changing to telehealth almost exclusively for extended periods, and working long hours in expensive and uncomfortable personal protective equipment (PPE). Some will also be touching base with COVID-19-positive patients at home after a long day, while others are trying to balance regular care and preventative care on a backdrop of community COVID-19 transmission. In other parts of the country, practitioners have only experienced short, sharp lockdowns where background medical care can safely wait for the lockdown period to end. On the flipside, these areas are far more likely to experience complacency – with patients opting to wait for their perceived desired vaccine or completely ignoring practice policies to inform staff if they have respiratory symptoms.
Each practice is different in terms of the profile of staff and patients, with constraints dictated by the physical building and the layout of the surgery. This can have an impact on the risk of COVID-19 should exposure occur and can also limit the practicalities of separating respiratory and non-respiratory patients. Some practices have the ability to use different waiting areas to ensure the two groups don’t mix. They may have enough staff to work in PPE continuously to provide a comprehensive respiratory service or be co-located with respiratory clinics where all respiratory patients are directed. For other practices, there is no safe way of seeing respiratory and non-respiratory patients in the same location, so they must re-direct respiratory patients to keep everyone safe. This variability can cause issues when patients or local hospitals see this as the practice not providing a service, rather than appreciating there may be limitations outside of their control.
For many practitioners, normal self-care activities are not available to them – often for extended periods of time. Gyms are closed and places of communal meeting are not available. Borders are closed and family supports may be cut off. Holidays are cancelled and leave is deferred until such time as safe travel can occur. Among outbreaks and lockdowns, many doctors have not taken a break in a long time. This compounds the stress of the increased responsibilities in primary care during the pandemic. There is the normal workload + vaccination clinics + working in PPE with socially distanced or outdoor waiting rooms + the lack of availability of leave and recreational activities, which can all lead to feelings of burnout. This is especially the case as the pandemic stretches on with no clear end in sight.
The lack of understanding of general practice adaptation during the COVID-19 pandemic, which is compounded by shifts in funding, means the role of general practice can be misunderstood in the community, other areas of medicine, the media, and the government – including the very department that provides funding and extols the importance of primary care. There seems to be an expectation that primary care can continually rely on the goodwill of the profession.
Many patients may not understand the need to revert to telehealth and minimise face-to-face contact. It may be interpreted as doctors “not providing required care” when the truth is that protocols are there to protect patients and staff and ensure the practice can continue to operate and provide a vital service. A practice which is forced to close due to COVID-19 exposure provides no care at all. Sometimes this perception is compounded by hospital doctors who are similarly not aware of the challenges of primary care.
What is obvious, despite the diversity of practice and the COVID-19 experience, is that there is one thing that unites all primary care practitioners; we can always be counted on to prioritise the health of our communities. General practice continues to adapt to each new challenge the pandemic presents, and has persistently pushed up vaccination numbers despite the restricted supply of vaccinations.
We continue to assess patients in the car park, in PPE, or over the phone.
We continue to have the same vaccination discussion, chipping away at the hesitancy and confusion our patients experience.
We continue to turn up each day and meet all these challenges in our own unique way.
This article is provided by MDA National. They recommend that you contact your indemnity provider if you need specific advice in relation to your insurance policy or medico-legal matters. Members can contact MDA National for specific advice on freecall 1800 011 255 or use the “contact us” form at mdanational.com.au.
Dr Sarah Taylor
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.