To see or not to see...

By Dr Dhruva Somasundara | Academic General Practitioner

Covid-19 has had major impact on how healthcare is delivered. Use of technology in medicine has increased exponentially- one of the few positives that Covid-19 has brought.  General practice consultations moved swiftly from being a predominantly face-to-face interactions to being a predominately virtual interactions supported by technical experts and technology while still maintaining the high quality of care that is the ethos of the NHS. 

We know that information gathering is a very important part of a consultation and that history alone is sufficient to make a diagnosis in over 75% of consultations (1). In my experience, individualised patient care, that is, delivery of healthcare tailored to the needs of the patient has increased. Though availability of technology to the patient and their ability to use these can be seen as limiting factors, these were overcome by offering a form of contact more suitable to the patient. The duration of telephone consultations remained the same as for face to face consultations, which allowed clinicians to conduct a thorough assessment on the phone.

An article published in The Lancet (2) suggests that healthcare workers have at least three-fold higher risk of contracting the virus.  General practice has continued clinical consultations with patients both face to face and virtually throughout the pandemic. However, face to face consultations with personal protective equipment were based on clinical need.

General practice (GP) played a particularly important role throughout the pandemic as incidence and prevalence of non-Covid illnesses remained unchanged. People still had non-Covid chest infections, patients on immunosuppressants for autoimmune problems were at high risk of Covid but required regular blood tests nonetheless, referrals were still being made to secondary care and new cancers were still being diagnosed. General practice has continued to offer services for all non-Covid illness but in a modified yet safe manner. We use a variety of methods of communication including telephone consultations, emails, video consultations and letters.

One of the challenges faced in general practice due to the pandemic is staying updated on the frequent change of advice and guidelines on management of Covid. This, in addition to other clinical guidelines. Working in a practice serving a deprived population brought with it the additional challenge of educating patients on the need to comply with restrictions. Patients with pre-existing mental health problems seemed to struggle most with this and it is the GP they turned to for support.

The callous attitude of some people to restrictions is much talked about. However, on the contrary, there is a risk that others who have been severely affected with anxiety due to severity of illness in a family member that presentations suggestive of post-traumatic stress disorder, are receiving little support. 

In summary, thorough telephone assessment of patients has been extremely important, not just to make a diagnosis and formulate a management plan but also to decide the need and benefit of having a face-to-face appointment. Transformation of healthcare delivery due to Covid-19 may be a more efficient way to deliver healthcare. The benefits are not just for the NHS, but for patients who are able to seek medical advice from the comfort of their own home and for the planet by reducing travel. 

1. Peterson MC, Holbrook JH, Von Hales D, Smith NL, Staker LV. Contributions of the history, physical examination, and laboratory investigation in making medical diagnoses. West J Med. 1992;156:163–165.

2. Nguyen LH, Drew DA, Graham MS, Joshi AD, Guo CG, Ma W, et al. Risk of COVID-19 among front-line health-care workers and the general community: a prospective coh1. Nguyen LH, Drew DA, Graham MS, Joshi AD, Guo CG, Ma W, et al. Risk of COVID-19 among front-line health-care workers and the general community: a prospecti. Lancet Public Heal. 2020;5(9):e475–83.