Fallout from minister’s comments intensifies as GPs stay home

Matt Woodley

10/03/2020 5:21:02 PM

A growing number of GPs with very minor ailments are unsure as to whether they should go into work as a result of Jenny Mikakos’ ‘dog whistling’.

Jenny Mikakos
Minister Mikakos said she was ‘flabbergasted’ that Dr Chris Higgins had presented to work ‘flu-like symptoms’. (Image: AAP)

Chair of RACGP Victoria Dr Cameron Loy told newsGP he has had personal contact with at least nine GPs who have called in sick as a direct response to Victorian Health Minister Jenny Mikakos, who criticised a Melbourne GP for going to work after returning from a trip to the US with minor cold-like symptoms.
The GP in question, Dr Chris Higgins, had initially hesitated to test himself as he did not meet the Victorian Government’s own criteria, but decided to do one ‘for sake of completeness’.
Dr Loy said the minister’s comments that she was ‘flabbergasted’, combined with references to the Australian Health Practitioner Regulation Agency (AHPRA) becoming involved, amounted to ‘dog-whistling’ and only served to confuse GPs already dealing with conflicting messages and inadequate supplies of personal protective equipment (PPE).
‘Minister Mikakos’ comments managed to completely unsettle the general practice community over the weekend and people who are low risk, maybe even no risk – they’re getting a snuffle – and they’re not coming in because they don’t want to be “flabbergasted”,’ he said.
‘I completely understand why GPs today are anxious about their status and are choosing to stay at home with the slightest sniffle. My problem is that that direction from the minister was so poorly defined that we are seeing doctors staying home when they probably don’t need to.
‘If the minister was going to say something like that publicly, it needed to be followed up by details about what that actually means for the general practice sector.’
newsGP has spoken to a number of GPs whose practices have been directly affected by Minister Mikakos’ comments.
Dr Karyn Alexander told newsGP she was one of four doctors who called in sick at her Altona North Clinic as a direct result of the comments.
‘We had 13 doctors rostered on today and four of us had to call in sick … so we’re basically down a third of the doctors,’ she said.
‘It’s been pandemonium … and I just feel that we’re being vilified.’
Dr Alexander said the comments likely have put Victoria’s primary healthcare system under increased pressure and contributed negatively to a public health response that has already struggled with mixed messages and a lack of access to equipment.
‘Overall, I’d say it’s been one big huge muddle,’ she said.
‘It’s just a mess. I’m not going to point the finger at any one person, but I wish that we could have had statements that were clear and coming from one source from the beginning.’
Another GP, Dr John Kramer, said two doctors had not come into work due to viral upper respiratory symptoms, even though his Woolgoolga-based clinic on the mid-north coast of NSW had not had a single confirmed coronavirus case in the area.
He told newsGP Minister Mikakos’ comments had contributed to the further fraying of the public health response to the virus.
‘I think she’s a disgrace. I’ve written directly to Daniel Andrews saying we’ve got no confidence in her. She should apologise or resign,’ he said.
‘It’ll only get worse because doctors generally, especially those in Victoria, will have no confidence in her.’
Dr Kramer said Minister Mikakos has exacerbated an already frustrating situation. His practice is yet to receive any PPE and the nearest hospital is 30 km away, meaning he is unsure what will happen to his patients should coronavirus spread to his area.
Minister Mikakos has attempted to defuse the situation and posted a lengthy social media post on Sunday night which addressed GPs’ concerns, defended her comments and insisted that her thoughts are with doctors ‘during this anxious time’.
‘There has been some significant misreporting on social media about the comments made by Victoria’s Chief Health Officer and I when we announced the case which I would like to clarify,’ she stated.
‘Most importantly, I did not name the doctor, despite calls from some for me to do so. We will always respect a patient’s privacy.
‘As we have been doing with each of our confirmed cases, we have identified potential locations of public exposure. For this reason, it was necessary to name the medical practice he worked in.’
Dr Higgins is one of eight GPs who works at the Toorak clinic, in Melbourne’s south-east, named in the media release announcing the confirmed case.
Minister Mikakos also denied suggesting Dr Higgins should be referred to AHPRA and insisted that current guidelines regarding testing are clear.
‘I did not refer the doctor to AHPRA for disciplinary action, nor did I say I would. I referred to seeking AHPRA to assist in providing advice to doctors about how they could better identify risks,’ she stated.
‘I also note commentary about whether or not the clinical guidelines were followed. I won’t comment on a specific case but generally, the DHHS [Department of Health and Human Services] advice is that doctors should exercise clinical judgement in determining whether a person travelling to any country with diagnosed cases potentially should be tested.’
Current guidelines set by the Communicable Diseases Network Australia and approved by the Australian Health Protection Principal Committee refer to ‘travel to (including transit through) a country considered to pose a risk of transmission in the 14 days before the onset of illness’.
Nine countries feature on that list; however, the US is not one of them. The Victorian DHHS has updated its own guidelines to include ‘international travel in the 14 days before the onset of illness’, but this occurred on 9 March, several days after Dr Higgins’ tested positive and Minister Mikakos made her comments.
Dr Loy said it is ‘bonkers’ that Dr Higgins may have been faced with differing guidelines had he been in a different state and GPs are suffering from politicians making statements that were ‘ahead of what’s actually taking place on the ground’ and designed for primetime news bulletins rather than assisting health practitioners.
‘We need a consistent message across the nation. The coronavirus is not going to be interested in state and territorial borders,’ he said.
‘The comments in particular on the Victorian Health Minister’s social media on the weekend suggest she’s already losing the confidence of the general practice sector.
‘She has a small window in which to repair that. We want to be part of this public health response, but the commentary from the politicians is not helping.’
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Dr Julie O'Brien   11/03/2020 6:45:17 AM

Hi. The written guidelines from our PHN is to test and isolate ALL health care workers with any respiratory symptoms. So it’s not just GPs being affected. Yesterday we had 4 out of 15 doctors away with minor sniffles. But we also sent home a Physio and radiographer.

Dr Hume Arthur John Rendle-Short   11/03/2020 7:01:29 AM

Stop the Blame Game.
I really think that BLAME is a major enemy in our management of the pandemic.
The aviation industry has a policy of Open Disclosure when they look into adverse events. So does the army, and those hospitals which have reduced their error rate.
Over the last day i have had a Corona virus related clinical situation. I pulled all the facts and considered the current QLD disease definition and travel rules and i made the decision. I was comfortable with the decision. But over night (isn't night a great time to entertain doubt) I questioned my decision. This morning my stress levels were huge. I was afraid. That if I had made the wrong decision I would be blamed, and my practice would be criticized. (If I was wrong a significant bussiness in town would have to send seniour staff home.)I would be on the front page of the local paper or worse.
First thing this morning I rang the Public Health Unit. They agreed that my decision was correct. My huge stress rapidly dissipated

Dr Hume Arthur John Rendle-Short   11/03/2020 7:02:37 AM

End The BLAME GAME (cont)
FEAR. A direct result of Blame. It will affect our decision making.
Over the next few months, poor decisions/unwise decisions/mistakes are going to be made. Blame will drive these underground. Both when the patient or clinician makes a regrettable decision. When these incorrect decisions are driven underground, the virus will thrive

Dr Thomas Anthony Shashian   11/03/2020 7:49:10 AM

I am a very disappointed general practitioner at present when it comes to how supported I feel by my government and the health department in general during this pandemic situation we are all facing.

Dr Ian Mark Light   11/03/2020 8:15:53 AM

In the specialist respiratory clinics in Victoria - the Alfred the RMH the Austin the Boxhill Hospital self testing is performed with a nasal flocculated swab and a throat swab -the self test nasal swab if a doctor has a runny nose a nasal swab is good according to a statement by Professor of Global Biosecurity Raina MacIntyre in news Gp 3/3/20.
Getting the result quickly within 24 hours by a rapid access for health workers is theoretically possible and ought begin because in influenza season there will be large numbers of people with coughs and colds .
For Doctors with mild symptoms who elect to stay away from the surgery this in when phone consultations Telehealth and phone prescriptions at least for repeats ought start .

Dr Jennifer Ann Butterley   11/03/2020 8:25:26 AM

One of the most frustrating aspects is the lack of expediency in gaining results from coronavirus testing. Currently the options are limited. One is to line up outside a public hospital for several hours waiting to be tested. General practice, with its elderly and immunosuppressed patients is not an ideal place for potentially infected patients to come for diagnosis. Nonetheless this is where many are being directed by the helpline. However, the process is far from streamlined. In our practice collected samples are sent in a bag to Melbourne pathology who don't undertake the testing but send them to a second laboratory. It's not clear how long it will take until results are known which is particularly difficult if some of our staff are waiting on them prior to returning to work with their mild respiratory symptoms. Surely a better solution would be to have the patients with mild symptoms attend a laboratory, have specimens taken with results known within 12 hours

Dr Peter Jui Hua Tay   11/03/2020 8:42:04 AM

She is still trying to deny what she said. her word" flabbergasted" was totally disrespectful and contemptuous. I have no confidence in her. She should RESIGN !.

Dr David Browne   11/03/2020 9:07:42 AM

I found that it is best to keep your head down, avoid any discretionary personal interaction with the health services, authorities or disciplinary bodies. Almost every medical professional shares a similar experience. From a personal perspective, the spread of contagion is better than the public thrashing of your reputation.

Dr Amirizal Bin Elias   11/03/2020 10:28:20 AM

Hey, may I suggest we call up the pharmacist who always want to perscribe, stock, supply and dispense their own medicine. We should get them to be in front line, screening corona virus. They are useful. They are willing. I'm sure their expertise and skill will come handy in obtaining alcohol hand wash and face mask/PPE.

Dr Peter James Strickland   11/03/2020 11:25:52 AM

The health minister here has made a silly mistake, or been advised badly. Thank goodness she is not a medico, or we would have someone who has mis-diagnosed the "case', and lead to an APHRA inquiry! She should step down or sack the staff who advise her on these matters, as she has now caused moderate panic and concern in the Vic community, and probably led to a loss of some GP services that were needed at this time, i.e due to GPs not attending to work due to minor virus infections NOT due to Covid 19

Dr William Robert Thompson   13/03/2020 7:49:23 PM

Doesn't sound like a genuine apology from the minister.
If she is not prepared to apologise publicly, the Premier should step in and suggest very strongly that she resign her position and appoint a better informed replacement .
.In the middle of such a potentially serious outbreak of the new virus in Australia we need all the help we can muster in our health system response and for a Minister of Health to name and shame a member of her front line troops this is an absolute disgrace

Dr Marie Jean Fox   14/03/2020 1:07:12 PM

Dog whistling draws attention to dogs breakfast

Dr Lisa M. Opie   14/03/2020 4:57:58 PM

Public shaming is a terrible way to treat anyone, and I am "flabbergasted" that the Minister has not resigned. The guidelines are still confusing: What happens to the family of suspected or proven Corona virus patients, who are not to self isolate but continue working (& spending,)
For example: my 17yo is home from boarding school with an URTI, not eligible for swabs. (Cue panic supermarket shop on the way to collect her, no one eats chocolate like a 17yo girl!!) If she's infected, I will need to self isolate. I had 2 days isolation with same URTI and fever, but eligible for testing so back to work this weekend. Should I send her out to our farm alone (it has terrible internet) until she's recovered? I am one of 2 VMOs for our hospital, so 14 days off, although possibly heavenly is not going to help.