10 Things I am going to do as a Doctor while '"Corona'' is in town

Written by: Dr. Anchita Karmakar MBBS BioMsc JD

My role as a GP Registrar and as a Senior Medical Officer in the public hospital system puts me in a very unique position of seeing what is happening in the hospitals and the community. I am so proud and happy to be part of this profession during these difficult times so that we can provide comfort, support, and reassurance to those who are vulnerable. As a nation, I believe Australia is in a great position and mind frame to make sure we protect our citizens and combat this situation appropriately. Part of this journey is to make sure we, as healthcare professionals are protected. Here are ten things I have told myself, I will be doing in my various roles. Again, as usual, I have to say, this is not legal advice as I am not a legal practitioner/lawyer yet and I am writing this purely as an editorial piece, stating what I would do personally. What you all do with this information is at your digression and risk.

1. If I wake up sick and think I need to get tested for COVID-19, I won't see patients until I get cleared 

There is no defense, when you suspect that one may have an illness and to be well aware of this, and then to continue seeing patients. It is in direct contravention of public interest so really, if I am sick I stay home. The current guidelines say that if you are a healthcare worker with symptoms you get yourself tested. On average it's taking about 48 hours for tests to come back so if I have to do this, I am going to give myself a little high five, get into bed, get my Netflix binge-watching list out and enjoy my valuable quarantine time at home. If I can't 'afford' to not work, I will contact my colleagues at DOD(https://www.doctorsondemand.com.au/) that offer telehealth medicine and conduct telehealth services at home to make some $$. Those of you that are VR Doctors, may be able to continue working remotely with the new medicare item numbers too!

2. I will cancel any planned overseas travel 

Other then for absolute family emergencies, I will refrain from traveling abroad at this stage. If I was not a healthcare worker and my main income source was not from healthcare I would not take such drastic steps, but I think currently, traveling for pleasure is going to potentially cause too much pain so no go for me. Travel insurance issues and money, as well as personal health and the need for breaks, are so important but I just can't risk it at the moment. If I do need a break, I will try and do things like long road trips, and or days off, simply at home, with family, enjoying each other's company, reading books and doing things that I would normally never have time doing.

3. I will make sure my documentations are adequate and contemporaneous when billing the new bulk-billed telehealth items 

First I will make sure the patient meets the criteria as per Medicare item descriptor for a telehealth consult. If they don't then I ask the patient to come in for a normal consult in the surgery. As part of the phone consult, I touch on things like contact tracing, who they have been in contact with including detailed flight numbers and travel plans so that if a positive come back I can help the authorities in contact tracing.

This is what I would write, altered for each patient of course according to their presentation-

*Phone consultation/telehealth consultation limitations explained and the patient consented to these limitations understanding the risks of no actual physical examination

 *The patient is not in any acute distress and or risk of deterioration requiring immediate urgent care and has been advised to seek further help if any change in symptoms

* The patient is part of A or B -

Vulnerable/isolated patients are those where at least one of the following applies:

(a) the person has been diagnosed with COVID-19 virus but who is not a patient of a hospital; or

(b) the person has been required to isolate themselves in quarantine by home isolation guidance issued by the Australian Health Protection Principal Committee (AHPPC); or

• (c) the person is considered more susceptible to the COVID-19 virus being a person who is:(i) at least 70 years old; or
• (ii) at least 50 years old and is of Aboriginal or Torres Strait Islander descent; or
• (iii) is pregnant; or
• (iv) is a parent of a child under 12 months; or
• (v) is already under treatment for chronic health conditions or is immune-compromised.

*The patient will be followed up with results appropriately and has been given appropriate advice regarding contact tracing and personal isolation and care

*Appropriate history, investigations, examination(only for video), implementation of the plan and preventative care undertaken with consent.  

I keep a little list of one's I am testing so I know I have to follow them up.

4. I will not panic

If we as healthcare professionals panic our patients and loved ones will have no chance. So other then my silent moments of craziness in my private space, I will continue to be calm, confident and well informed. I always try to think, whats the two worse things that can go bad. I can die or not be able to earn a living for a little while. Both are not that bad, to be honest, and as long as I have my insurances sorted which will take care of my family in my absence I should be ok. What I don't want is to be part of mass panic, creating an unsustainable, unsafe healthcare system for my loved ones and patients. So, lots of breathing, meditation, and self-control.

5. I will make sure I am always providing reassurance and support to my patients and loved ones 

I would like to maintain my ongoing pride as being the "Doctor". Yes, I think this title comes with some shape or form of a 'stature' to maintain and these are the times we must maintain that coolness. In reality, we are no different from our patients, but I think we need to be their pillars and strengths when people are having very real fears and anxiety from these dark and difficult times. As my great father always reminds me, "Life is acting and we are all actors on the great big stage". So true. No matter how crazy and scary this journey maybe, I would like to think that I can provide evidence-based, good solid reassurance and support to my patients and loved ones.

6. I will look into my health both physically and mentally 

This is my weakest point. I am not the golden child of health, so especially now, one of the best things I could do is to make sure I eat well, sleep well, take my medications and optimize my health. That is virtually all we can do to survive Corona or any other virus, so let's start here.

7. I will re-visit my skills of hygiene and PPE methods 

My boss asked me a great question the other day when I did my first swab of a patient with potential Corona. "Did you exercise proper PPE methods?" To come to think of it, I did, but only because my awesome nursing staff prompted me to make sure I am using the right mask, gown, and washing up techniques. So, now I think is the best time to go through these techniques, do an inventory of any gear you need and protect yourself, your staff and your loved ones. On top of the PPE requirements, after coming home from work, I make it a habit to go straight into shower mode, wash my clothes and get into my comfortable home clothes so I don't carry any potential bugs to my beautiful family at home. Probably won't be a complete proof but you do feel a lot relaxed doing this in my opinion.

8. I will be vigilant to identify and advocate for my patients who are at high risk 

I would like to start looking into potentially doing a mail-out to our current patient loads, who are identified as high risk and perhaps offer advice and support for these people actively instead of just as a reaction to their presentation. Lists can be created quite easily through practice software so that would be my starting point.

9. I will refrain from attending any conferences or group activities 

Any group gathering is not necessary for my opinion. Most can be done digitally so why not use our digital technology and minimize exposure!

10. I will make sure I get my flu vax and continue to have faith in our healthcare system

On a final note, yes, unless contraindicated, I would like to see us all get our flu vax as you don't want flu and corona to be together!! And, most of all, let us all keep our kindness as our driving force, work together with our awesome group of healthcare professionals, remembering we are all in this together and in union, we shall prevail.