After the CoVID-19 deluge

What will happen to our healthcare services once the acute phase of CoVID-19 has passed is anyone’s guess. The backlog of non-urgent surgery and medical treatment grows daily as physicians not involved in acute life-threatening care are furloughed and patients are reticent to see clinicians for fear of catching CoVID-19, if their offices are even open for face-to-face consultations.

CoVID-19 phobia can turn seasonal allergies into something more sinister.

Clinicians and patients are not very skilled at negotiating healthcare priorities. Unfortunately, beyond end-of-life decisions, there is little evidence to give guidance on how patients or clinicians should decide which health problem to address in what order.

When patients with multimorbidity are asked to identify their priorities, they answer in generalities: maintaining independence, staying alive, and relieving pain and symptoms. This wish list doesn’t translate well to the disease-focussed health care systems that clinicians work under, and gives physicians little guidance on how to conduct consultations or treatment.

For clinicians, the most comfortable approach is dealing with acute problems such as hypertension and diabetes, for which there is ample evidence and professional guidance.  Chronic and co-morbid problems such depression, dementia and disabling arthritis are often overlooked even though such problems can equally affect a patient’s quality of life and life expectancy.

If the response to CoVID-19 continues to pervade the rest of the healthcare system, it will intensify the focus on acute problems, even if they are not serious. We have already seen the impact of this type of conjured urgency. For example, CoVID-19 phobia erroneously can turn slight fevers, headaches and coughs that may merely be seasonal allergies into something more sinister.  Tracking apps and medical websites only magnify the fear many of us have than any cough or sneeze may morph into full blown CoVID-19.

Alternatively, if in the post CoVID-19 era, there is an incentive for clinicians to deal with complex chronic problems, we have hope for a more equitable system and more efficacious prioritisation.  Physicians and patients need to work together to determine what specific issues to address in a given consultation by considering whether problems are urgent or non-urgent, serious or not serious and what outcomes are possible.

4 thoughts on “After the CoVID-19 deluge

  1. As a clinician not dealing with acutely ill patients with covid 19, I’m not furloughed! I’m still seeing patients in general practice. My colleagues conduct video consults and any patient whom they can’t sort out comes to the health centre for a face to face with me.
    These patients may just need someone to palpate their abdomen, look in their ears or listen to their chest. But some have complex medical problems, multiple illnesses, with psychological and social issues all mixed together. Helping these patients is what good experienced GPs do all the time. Sure, it’s more tricky when patients are frightened that they may be developing Covid-19 (and some that I have seen are in the early stages) but we can handle that. Evidence based guidelines are not very helpful with this group of patients, so we have to make clinical judgements in conjunction with the patients (and maybe their families, too).
    For the past six weeks, I haven’t been able to refer some patients because the hospital services had been switched over to providing covid care. ENT is too risky for the doctors, the anaesthetists running the sleep clinic have been transferred to the expanded ITUs, for example. But I could still refer suspected cancer patients and the acute chest pain service was still available. The situation is now changing and I can refer a wider selection of patients.

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  2. This a totally excellent. Primary health care and holistic health promotion will potentially return to the dark ages as the narrative around those working in ICU talks of Heroes and Angels. Please write more about this topic with your usual insight and recourse to evidence about health behaviours and health care professional behaviours.

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