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I’m on the frontline in the war on coronavirus – but as a GP, my surgery is quieter than ever

Tiredness presentations are down, and there are fewer heart attacks. Could this be because people are not at work?

Berenice Langdon
Friday 17 April 2020 13:11 BST
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UK coronavirus lockdown extended for three weeks, says Dominic Raab

As a teenager I never understood why soldiers were so keen to get back to the front. But after an accident and eight weeks on crutches all I want to do is, firstly, to be able to walk again, and secondly, to go back to the NHS frontline. When asked by family and friends about the risk of my catching Covid-19, I just shrug; I want to be there.

To start with, on my return, I only manage telephone calls and no face-to-face consultations. Examining a patient and using crutches is an impossible combination when hand hygiene is so important.

But one morning, I hop into work and find the door locked and the lights off. The surgery is open; when I press the buzzer a gloved and masked figure is dimly visible through the glass. The door is unbolted and I am let in by a receptionist, clearly uncomfortable, wearing a surgical mask. Now everyone is in the same position as me: telephone consultations only.

The surgery is quiet and cool, the corridors dim and empty, just the one-sided sound of telephone conversations comes from consultation rooms as each doctor, naturally separated from each other, carries on with the work. I am just pleased to be back at work helping out.

It’s amazing how far you can get on the telephone. I diagnose a knee problem and later on a kidney issue. In fact, I have a lot of experience at this, having worked previously at a practice that only offered telephone consultations. So I slip easily into a skill set I hoped never to use again. But once this is all over, I will stop.

But to everyone who says remote consultations are the future, I say no. Having done it for five years, I think I have an informed view of the process. They take longer, are less effective, and involve a lot of time-wasting negotiations about who and when someone should come into the surgery. Out of every 15 patients, we would generally bring in six for a face-to-face, either for an examination or just to talk more freely.

Of course, telephone consultations mean most patients don’t have to come in and wait around in the waiting room. But if there is one commodity that we have plenty of in this country, it is people’s capacity to sit and wait. Doctors’ time, not so much.

When I finally moved jobs from that role, the speed and efficiency of an ordinary surgery’s appointments delighted me. The pleasure of seeing patients, the ease of having a conversation together and in person, is something I enjoy every day that I work. Of course I am not blind to some of the advantages to phone consultations – they are less tiring, and it doesn’t matter so much to other patients if some consultations end up taking longer than expected. And I can get up to make a cup of tea at any point. They are a great solution in the middle of this crisis, but as far as I am concerned remote consultations are a temporary measure only.

I notice that a lot of telephone slots are being used for prescription requests. When patients start asking me to email prescriptions to pharmacies in Suffolk and Scotland, and indeed all over the country, I realise that people are leaving London. I take two calls about Covid-19, from people suffering the minor viral infection variation. Another caller has an extensive travel history so I advise the 111 online questionnaire to establish if they are eligible for a test. I had tried it out earlier in the day, checking out all the yes/no options and thought it well designed, asking the right questions on symptoms and patient functioning. Can you eat and drink? Can you still watch the television?

As the chronic illness letters filter through from the government, I have calls from patients who haven’t received one and want to know why not? Every now and then a call is from a patient requesting a sick note, worried about catching Covid-19 while at work. I sympathise, but I can’t give sick notes for that.

The trouble now is an unusual one: there are not enough patients to go round. Where normally I get in and find all surgeries fully booked apart from a handful of afternoon emergency ones, now I come in and the situation is reversed. Each doctor has five or six appointments booked in for the morning; the midday and afternoon clinics are empty.

I beg the receptionists to fill up my surgery first. They do, as a favour, as I try to figure out where all the patients have gone. Are patients being kind to doctors? Or just more responsible about taking up our time? Could they simply be perfectly well? Staying at home does reduce the spread of all sorts of common infections – ordinary coughs and colds, tonsillitis and sick bugs.

Tiredness presentations are down, and there are fewer heart attacks also. Is this because people are not at work? Major trauma rates are markedly reduced – less traffic means fewer road traffic accidents.

But there must be some people with illnesses ticking over and needing our help.

I want to be part of the frontline and play my part and carry on. I know I am part of the plan, that general practice should continue as much as usual as possible. It’s what I am trained for: to look after all of those other people who need healthcare and don’t have Covid-19.

And that’s what I’ll carry on doing – as long as the receptionists can scrape up any patients for me.

Berenice Langdon is a GP working in southwest London. She has also been a rural doctor in Australia. Her interests are microbiology, genetics and public health, and she is the author of ‘​Learning Microbiology through Clinical Consultation​’

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