What’s up doc? Get on top of health before corona axe falls

CLARE SMITH: By phone or even in the carpark, now is the time to manage your health issues

CARE: We should be making sure everyone with a chronic condition has their management plan right up to date.

These are strange times, and an unexpected oddity is that GPs right now are doing very little. People think we are very busy, and that they are doing us a favour by staying away, but this is not the case.

It is true we don’t want to see you in the flesh, but what we really want is to be right on top of all health issues as they arise right now, before the corona axe falls. We want to talk to you and make sure your asthma, allergy, hypertension or other plans are up to date. Is your diabetes under control and how is your heart failure or respiratory disease? Are your scripts in order, and which is your local pharmacy? Are there new issues to be sorted out?

We are all learning how to do Telehealth on the run, and we should be making sure we and our patients are comfortable making the best use of technology to get assessed, triaged and treated while the rate of coronavirus spread is relatively contained. We are learning from colleagues in other parts of the world who have been using these technologies for years about how to assess a patient remotely. It turns out we can get people to give us lots of important information by carefully instructing them on self-examination techniques and reporting the outcome. You can hear them cough, find out the pulse rate, temperature and how long it takes for them to need a new breath while counting to 30. If we are worried, there are various other options. We can arrange blood tests and imaging by phone. fax, etc. We can refer to COVID-19 clinics if appropriate. We can decide on new or altered medication and arrange for scripts to go to local pharmacies, who have delivery services lined up. If necessary we can organise for some patients to come to the surgery for further clinical assessment. Appointments for face-to-face visits can be staggered so there will be few or no other patients in the building. Triaged patients can call us from the carpark, and we can go to their car and do a basic examination — not perfect but often adequate. If necessary, we can meet them at the door, wearing PPE if appropriate, and perform an examination, an ECG, sew up a laceration or remove a skin cancer that can’t wait.

Right now we should be making sure everyone with a chronic condition has their management plan right up to date. We want to check medication lists are correct, and that the pharmacist is working to the same one. We need to consider what can and what can’t be put on hold. Specialists are available for phone consultations and referrals may need to be organised. We want to make sure other members of the treatment team are informed.

Every new set of symptoms needs to be sorted out sooner rather than later.

Many people are struggling with the mental health impacts of this pandemic and the social isolation imposed on us. GPs can do mental health plans by phone and psychologists can offer appointments by phone. Not as good as face-to-face — but a whole lot better than nothing and whole lot better to be establishing those relationships now before things get worse.

Anyone can ring and make an appointment to see their doctor by Telehealth. All that is required is that the patient can be accessed by phone at or around the time of their appointment. The doctor will then call them, get consent to consult after checking the usual three items of identity, and then proceed to find out what is the problems, and work out how best to solve it.

Influenza vaccination is coming, but none of us knows quite when. (Reception staff don’t know either — it will be in the newspaper as soon as it happens.) Nevertheless, plans are being made for clinics to run as smoothly as possible, with safe supervised after-vaccination waiting areas.

So please, if you are unwell, worried, need a review or your GP management plan is out of date, make an appointment.

Dr Clare Smith is a general practitioner at John Street Medical Centre in Kingston.