Clinics switch to telephone-only to ward off virus threat

Doug Hendrie

16/03/2020 4:26:44 PM

A prominent GP has moved away from in-person consultations after potential exposure in one of his practices.

Woman using telehealth
Telehealth has been used effectively overseas to tackle the coronavirus. Can it help here?

Dr Todd Cameron took the drastic step across his three M3 Health clinics in Melbourne after a patient lied about their travel history and symptoms in order to be able to see a GP.
That left the GP potentially exposed to coronavirus, as they had no warning to allow them to use masks or isolate the patient. The risk was lowered, however, due to earlier social distancing efforts by clinic staff.  
‘People are fearful. They’re going to lie. Humans are going to be human,’ Dr Cameron told newsGP.
‘The doctor had an appropriate distance [from the patient], but this is increasingly going to happen. It’s naive to believe you can prevent people coming in, especially when a reasonable proportion don’t have symptoms.
‘If we’re telling people to socially distance themselves, but that it’s fine to pile into a doctor’s clinic – that seems stupid.’
That incident prompted Dr Cameron to accelerate the move away from in-person consultations and shut the doors of his three clinics.
He has also closed his Ascot Vale clinic to use as a ‘burner clinic’ or central operations area if he needs an area guaranteed not to have coronavirus contamination. The clinic has been offered to the local Primary Health Network for use as one of the forthcoming fever clinics, if needed.
‘Moving to telemedicine for everyone has been highly appreciated by doctors, patients and staff,’ Dr Cameron said.
The Federal Government made new telephone and video call Medicare Benefits Schedule (MBS) item numbers available on Friday.
RACGP President Dr Harry Nespolon has urged the Government to expand the scope of the new telehealth options as a way to reduce the risk of having potentially infected patients gathering in practice waiting rooms.
‘Facilitating more telephone consultations makes sense rather than having sick people turn up in a crowded GP clinic waiting room where they can spread the virus to others,’ Dr Nespolon told The New Daily.
‘It’s straightforward, it’s accessible for all people in the community and it will help in combating COVID-19.’
Dr Cameron has been agitating for faster movement on the coronavirus, warning that Australia’s increasing rates of infection mean the country could be two weeks away from becoming a virus hotspot – unless strong action is taken to slow the spread.
Under the new telephone-only policy, GPs at M3 clinics will undertake clinical diagnosis of coronavirus over the phone and direct possible cases to a government testing station.
Dr Cameron admits the move is pragmatic, given challenges sourcing personal protective equipment (PPE) and the need to ensure GPs remain safe from infection.
‘We only had PPE for eight cases, which is similar to most clinics,’ he said.
‘Our biggest job is to ensure our current patient population is well and applying appropriate social distancing, with an appropriate supply of medications, and don’t unnecessarily present at hospitals.
‘We know that most COVID-19 can be managed at home. Our job is to reduce the workload on hospitals, as we know it will be massive in coming months.’
Dr Cameron’s clinics are using telephone-only MBS items to avoid any teething issues with video calling over the internet.
Only last week, all M3 clinics had social distancing guides – in the form of gaffer tape on the floor – installed to indicate to patients what 1.5 metres of distance represents, while reception staff were instructed to avoid physical contact, such as holding a Medicare or credit card.
Other practices are following suit on social distancing after Dr Cameron publicised his approach on social media.
Dr Cameron acknowledges that the temporary shift to telemedicine will come with a pay cut, but he believes it is safer than the alternative.
‘Having patients with coronavirus pile in here next to little kids who will pass it around – it’s not safe,’ he said.
Dr Cameron said early action is vital.
‘Being a week ahead is like a month at the moment. We have an important leadership role in the community to encourage safety,’ he said.
‘A pandemic can end in two ways, through immunity from the virus or immunisation from a vaccine, and both are a long way off. This is a marathon.
‘We’re about to see widespread social upheaval. I don’t know how you prepare for it, but you need a certain plan even if you’re uncertain about the outcome.’
Overseas, telemedicine has been used to reduce the risk of coronavirus spread in nations like China and South Korea.
The CEO of telehealth software maker Corviu Dr Silvia Pfeiffer told The New Daily that the coronavirus would likely lead to a major uptake of telehealth globally.
‘[It’s] one of the best ways to get [the virus] under control’, she said.

The RACGP has more information on coronavirus available on its website.
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Dr Michael Lucas Bailey   17/03/2020 7:46:39 AM

Unfortunately the new item numbers don’t seem to allow clinics to go to full phone consults. As I understand it, there are basically only 3 acceptable reasons for a phone consult:
1. The patient is a suspected case or
2. The patient is in a vulnerable population or
3. The doctor is in isolation as a suspected case.

Unfortunately this may fit most, but not all consults. Ideally the MBS item needs to be expanded to include all patients.

Dr Myfanwy Gwynneth Sahade   17/03/2020 8:42:37 AM

Totally agree. Dr Cameron may have to wear a large income reduction- performing free tele-consults or possibly charging a fee depending on the demographics.

Dr Fiona Jane Henneuse-Blunt   17/03/2020 8:44:16 AM

In the UK all my ex colleagues have closed their doors to all but emergency cases and there is a triage system in place. It works there because of the capitation payment system in place. I too had a patient blatantly disregard advice not to enter the health centre yesterday. It's a minefield.

Dr Debbie McKay   17/03/2020 9:31:00 AM

Telephone assessments for everyone, with appointments for medically required examinations only is looking good to me. I am considering a private fee for those that do not qualify for the MBS items. But I have a typical suburban practice - how would this look for other patient populations?

Dr Vera Nikolic   17/03/2020 3:46:42 PM

But we are still doctors and patients still will suffer from all other conditions ,not only Corona virus. Who is going to treat AMI, wounds, asthma attacks etc ?!. No I am not going to close my practice as long as I can safely care for my patients and myself. Telehealth is otherwise great way to go in this situation and I have a lot of phone calls done today.

Anonymous   19/03/2020 9:27:49 PM

If we close our GP clinics then we are doing more harm to the community and will push our public health systems and hospitals to breaking point. We signed up for the job and are aware of the occupational hazards in what we do. We should be diverting any suspect cases, in line with the current guidelines, to self isolate and or visit a Covid Clinic set up by the government. Screen patients before they come to the GP clinic - whether that be before entry and or over the phone. We should not close as that is just cowardly in a time when people need us most. This is what the job is about. This is almost a war time effort right now when we have the military helping out our production of PPE given its short supply. Screen people more strictly and make your practices more safe for your other patients and staff and stay open because the general public still need access to their GPs especially during this time when our health systems are under pressure.