GPs given advice on mental health, PPE and vulnerable patients

Anastasia Tsirtsakis

7/08/2020 2:34:23 PM

Senior health department officials have answered GPs’ pressing questions about Australia’s COVID-19 response.

Deputy Chief Medical Officer Professor Michael Kid
Deputy Chief Medical Officer Professor Michael Kidd thanked GPs for their ‘extraordinary work’. (Image: AAP)

As Melbourne navigates the harshest restrictions in Australia since the pandemic began, Deputy Chief Medical Officer Professor Michael Kidd has acknowledged Victorian GPs are under ‘a huge amount of pressure’.
Professor Kidd made the comments in the latest Department of Health (DoH) ‘COVID-19 response update for General Practitioners’ webinar, which was hosted by the former RACGP President, along with Principal Medical Advisor and GP Dr Catherine Kelaher, and rural GP Dr Bili Malek.
‘This week we particularly want to focus on the challenges that colleagues in Melbourne and across the state of Victoria are encountering during the increase in the restrictions which we’ve seen in the state over the past week,’ she said.
However, the webinar also included valuable information for all GPs who may encounter suspected or confirmed COVID-19 patients, as well as those with patients who are particularly vulnerable to the disease.
For patients who are at high risk of severe illness, Dr Kelaher said it is important to have a plan in place to better manage lockdown.
‘So some of the things they should consider as part of their plan is thinking about where they live, who’s coming to their house, and do they need any additional protections in place while they’re at home,’ she said.
‘If you have people coming in and out and going to work, then you might need to consider additional protections in your home.
‘They need to consider how they’re going to manage their healthcare while they’re in lockdown. Are they going to access GPs by telehealth? How will they get their prescriptions? They need to have a plan in place to manage that.
‘They also need to think about food and deliveries, how they’re going to exercise and stay healthy, how they’ll stay in touch with their support people, and they need a plan in case they become unwell.
‘So getting all that formalised will help people cope in lockdown.’
Dr Malek said it is also important for GPs to continue being mindful of the mental health impacts of the pandemic.
‘Anyone in our community who has an underlying mental illness of any sort, including ourselves, including the healthcare providers, if you already have mental illness in the background or previously, it doesn’t take much to have that resurface,’ she said.
‘We are also being very vigilant as GPs about the increase in domestic violence and the way that that’s playing out in our community, because people are locked in more together.
‘We’re seeing, I’ve been told, more presentations in emergency of domestic violence, where that’s the only place that person can go. So there is a need to be very vigilant about the needs of our patients in that way.’
Given the high rates of community transmission in Victoria and confirmed cases emerging in other states, Dr Kelaher advised GPs to continue to refer to advice from the Infection Control Expert Group, and to update practice protocols in accordance to keep practice staff and patients safe.
‘That advice for healthcare providers is that for close clinical interactions with your patients you wear a surgical mask, you do a risk assessment and decide if you want to have further protections, including eyewear or other protections,’ she said.
‘If it’s an unwell person, it should be contact protection and a mask and eyewear. And then if you’re doing aerosol generating procedures, the advice is avoid unnecessary procedures.
‘If required, then you need to do contact, airborne protection and eye protection, and the airborne protection is to wear a P2 or N95 mask.
‘It’s so important that everybody is aware how to use them and that the mask is fit tested. Following that procedure, then the room obviously should be left for a period of time, and that’s 30 minutes.’
Dr Kelaher extended the advice for use of surgical masks to reception staff also, but for those not in a COVID-19 hotspot, she said mask use should be based on risk assessment.
‘The GP practices that have put the barriers in place, they’ve undertaken those controls as part of … risk assessment. If you haven’t put a barrier in place, you may consider using masks,’ she said.
‘But using the hierarchy of control, barriers are superior to masks. So if you can, that would be a better approach. But if you can’t, then a mask should be used, particularly if they’ve [the patient] got respiratory symptoms.’
While surgical masks are the gold standard, depending on the workplace and community transmission rates in the area, Dr Kelaher said that a cloth mask could be sufficient in some workplaces.
Questioned on the duration a mask should be worn, she said it would be dependent on the type of mask and on the environment in which it is being worn.
‘Always comply with the instructions of your infection protection and control group, and also consider the manufacturing instructions,’ she said.
‘They usually will say a maximum of four hours, but it varies, depending upon the type of mask that you have.
‘But if your mask gets damp or damaged in any way, then you need to remove it. If you need to take it off, you need to put a new one back on.’
For people who have difficulty wearing a mask due to respiratory illness for example, Dr Kelaher said a face shield would be satisfactory.
‘Wearing a barrier is better than wearing nothing or wearing it inappropriately,’ she said.
‘I would ensure that they do wear something if possible. And obviously, if they’re not appropriately protected for whatever reason, then the healthcare provider might consider a higher level of protection for themselves.’
Dr Kelaher also said that clinics should be mindful of how personal protective equipment (PPE) is disposed of, to avoid contamination.
‘Routine disposal of masks for people in the public would just be in your normal rubbish and bagged,’ she said.
‘But in the clinic where there may be a higher chance that there would be a contamination in terms of a respiratory infection, be it COVID or another one, then we would dispose of it in accordance with our normal contaminated waste disposal.’
As GPs tuned into the webinar across the country, Professor Kidd reminded them to continue encouraging patients with respiratory symptoms to get tested, ‘no matter how mild’.

Reception staff in COVID-19 hotspots are advised to wear face masks.
‘We do know that there is community transmission in New South Wales, as well of course as the extensive community transmission in Victoria, but we have also seen the occasional cases which are being picked up in some of the other states,’ he said.
‘So please continue to encourage your patients wherever you are in Australia to carry out testing.
‘Our GP respiratory clinics continue to be very busy conducting testing, but also providing assessments of people with respiratory symptoms which may or may not be related to COVID-19.’
Professor Kidd gave particular acknowledgment to colleagues running GP-led respiratory clinics in Melbourne and across Victoria.
‘We know that there is increased work which is being carried out by those clinics,’ he said. ‘Thank you to our colleagues who are leading those clinics.’
Dr Malek, who works in Queanbeyan in rural NSW, said both telehealth and having a local respiratory clinic set up as part of an extensive COVID-19 strategy had helped local GPs significantly – but added that the triage process has not been foolproof.
‘The biggest problem has been where patients have answered all the triage questions as “No, no, no, no, no”, and then come in and say “Well I want you to help me with my cough”,’ she said
‘There’s a little bit of a disconnect sometimes in what the receptionist thinks that she said, what the doctor believes has been triaged, and what actually comes in the door.
‘I’ve seen this also down the coast when I was talking to my students about two weeks ago. Very similar problems. So it’s not restricted to this area.’
While GPs are focused on the task at hand, Dr Malek admitted that there is ‘a low level of anxiety’ across the board.
‘Many of us also have colleagues overseas, and some of those have died and some of those are very ill still,’ she said. ‘So we’re very conscious of that as a background noise.
‘We as a group tend to like to work pretty hard and go very fast and then have a few days break, and we haven’t been able to do that as professionals.
‘Being aware of our own levels of stress and anxiety is so important.’
Professor Kidd shared the sentiment.
‘Black Dog’s The Essential Network is available with specific resources to support the mental health and wellbeing of healthcare practitioners, including those of us working in general practice,’ he said.
‘To our colleagues in Melbourne and in Victoria, thank you for the extraordinary work that you are doing continuing to provide care to your individual patients and to the members of your community under very challenging circumstances.
‘To everyone else across the country, please continue to do the great work you’re doing. Please stay safe.’
Useful resources for GPs 

GPs can also access the ‘Responding to a COVID-19 case in the practice team’ fact sheet on the RACGP website.

This article has been updated after it incorrectly referred to Dr Bili Malek as ‘he’.
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