GP efforts in the coronavirus fight ‘inspiring to witness’

Anastasia Tsirtsakis

9/04/2020 1:19:35 PM

Dr James Best discusses the challenges and trauma involved in ‘what is possibly the most trying professional experience in our lives’.

Dr James Best
Dr James Best says staying socially connected while physically distant is critical to maintaining mental health during the pandemic.

‘This is not a sprint, this is a marathon.’
That is how Nowra GP Dr James Best describes the unfolding coronavirus crisis.
Like many other GPs, and thanks to the recent telehealth expansion, Dr Best has been able to continue treating his patients while self-isolating. He recognises the enormity of rolling out practically a decade’s worth of reform in just weeks, and says it has been a very emotionally challenging time.
‘There’s been a lot of workplace and workflow disruption, including for practices financially in terms of patient numbers and having to dismiss staff, including doctors and registrars,’ Dr Best told newsGP.
‘We’re all having to get our heads around very quickly what can and can’t be done on telehealth, and how to triage at different levels and in different environments.’
This new reality, Dr Best adds, has been accompanied by the realisation that inevitable changes are made in terms of care that can be provided without face-to-face contact, and calls trying to minimise that ‘challenging’.
‘We all want to do the best for our patients, but we also have to realise safety limitations and such,’ Dr Best said. ‘If you’ve got a whole bunch of elderly patients being dragged into waiting rooms, obviously that’s a very unsafe situation.
‘It’s been very traumatic for everyone involved, both doctors and patients.’
As Chair of the RACGP Specific Interests Child and Young Person’s Health network, Dr Best has noted angst ramping up in recent weeks regarding possible impacts on the young amid debates around school and daycare closures.
While the virus is said to pose less risk to children and young people, it certainly isn’t zero risk; child deaths, albeit rare, have been reported overseas
‘Certainly, the anxiety held around the health of children is always so intense,’ he said.
‘There was a lot of parental anxiety, including children of doctors and people who are working on the frontline.
‘At the college level, there’s been a huge amount of activity being required in terms of getting messages out, being clear, being consistent, trying to reassure our members and the public as well.’
But Dr Best says the silver lining has been witnessing the GP community unite to face these unprecedented challenges head on, together.
‘There’s a certain communal spirit. Knowing that this is a crisis and trying to do our best and contribute in whatever way we can in what is possibly the most trying professional experience for us in our lives,’ he said.
‘We’ve witnessed in the last few weeks what have always been considered insurmountable barriers repeatedly smashed apart. We’ve heard for years and years that it was impossible for primary care to widely adopt telehealth, and yet we’ve seen it happen virtually overnight.
‘It has been very inspiring to witness.’
Given the prolonged period of uncertainty society is now facing, Dr Best believes it is important GPs remember to look after not only their patients but also one another, professionally and socially.
‘Where are we going to be emotionally in three or four months? Where are we going to be mentally, at a community level and at a primary care level? I think we have to start thinking along those lines as well,’ he said.
‘The mental health tsunami is going to follow the physical tsunami of the actual virus and its complications.’
Drawing from Professor Ian Hickie, Dr Best says it is critical to shift the terminology from social isolation to physical disconnection.
‘We need to stay connected using whatever technology we can,’ he said. ‘At a primary care level, the difference between telephone contact and audio visual contact – seeing somebody’s face – is actually quite significant.
‘If we have a frail, vulnerable, socially isolated elderly person in the community, a video consultation with her doctor that she’s known for decades could be really, really important.’
Following on from the bushfires in Australia earlier this year, Dr Best says it became evident that general practice is often the ‘lost voice, especially in disaster planning’, but the current health crisis has highlighted that GPs ‘should be a cornerstone’. 
‘If we can deal with keeping people away from the emergency departments, away from the testing facilities, then it reduces the pressure downstream, so general practice is fundamental,’ he said.
‘And of course so many of us have these wonderful connections to our patients where the value of trust to reassure and to deal with not only the physical consequences of a virus in the community, but also the flow on, what happens emotionally and mentally down the track.’
While varying estimates have been reported, the pandemic’s true trajectory remains unknown. But whatever the future holds, Dr Best believes continuing to work together to maintain momentum is key.
‘We have to act in terms of the short term to deal with the long term. Focus on what we’re going to be doing next and be thinking laterally and imaginatively; to not let that anxiety restrict our decision-making process,’ he said.
‘I’m quite proud of my GP community in the way that it has responded. But we’ve just run the first lap of a very long race. We have to keep pushing.’
The RACGP has more information on coronavirus available on its website.
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Correction: This article has been updated to reflect the fact Dr Best now works in Nowra,
on the south coast of NSWnot Sydney as originally stated.

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Dr Irandani Anandi Ranasinghe-Markus   10/04/2020 9:50:10 AM

Wholeheartedly agree with Dr Best’s observations. I am also a Sydney GP and am delighted that General Practice has been acknowledged as being a key player in the fight against a Corona Virus. We, in primary health care have had to address several different aspects of the crisis including screening of symptomatic patients, managing COVID positive patients at home and escalating care for those that needs admission, addressing the anxiety relating to the virus which is enormous and widespread, taking care of the frail and vulnerable in our society such as the elderly, the pregnant and the very young. We are doing all this whilst maintaining important day to day care of our chronically ill patients a well as practicing the important aspects of preventative care which can not be postponed or forgotten about. Access to Telehealth has taught us all that it is not that hard, it works for nearly 75 % of our workload and it is a much more environmentally friendly way of working.