GPs left exposed as symptomatic patients flout triage protocols

Anastasia Tsirtsakis

19/07/2021 4:58:35 PM

Concerned GPs say practice staff need to be better protected, following the listing of several general practices in NSW and Victoria as COVID-19 exposure sites.

A patient going through triage questions.
Despite most general practices having stringent triage processes in place they have not been foolproof, GPs say.

Last week, Melbourne GP Dr Amaninder Sekhon received the call every practice owner has been dreading for the past 18 months. His clinic had been listed as a COVID-19 exposure site.
A patient, who tested positive to the virus, had entered the building to attend a radiology service that shares the same main entrance, classing Dr Sekhon’s practice as Tier 2.
‘It was a bit of a shock,’ he told newsGP.
‘We were lucky in a way that we’ve got telehealth arranged at home [as] I had to finish my morning session and go for testing. We [also] had to cancel a few face-to-face patients and call the ones which we were able to call.
‘From a general practice point of view, we are really under a lot of stress and anxiety about who to see and who not to see. It’s not easy.’
As community transmission continues to spread across Victoria and New South Wales, a growing list of healthcare settings have been named as hotspots, with at least a dozen general practices currently classed as exposure.
Most, if not all, general practices have stringent triage processes in place, but Sydney GP Dr Imaan Joshi says those processes are not foolproof as they rely on patients being honest.
‘A GP friend of mine is now isolating for [two weeks because] a [patient] lied to her for a face-to-face and is COVID positive. I am livid. And sad for her and her family,’ she recently Tweeted.
Dr Joshi received numerous replies from GP colleagues across the country empathising with the experience, among them Queensland GP Dr Tammra Warby.
She told newsGP that despite her practice being guided by official pandemic advice, routinely screening patients at the time of booking and again at reception, practice staff have still been put at risk.
‘We’ve had practice protocols we’ve been solid on the whole time. Do you have cough, cold, flu-like symptoms, sore throat, headache, runny nose? Have you been to a hotspot in the last two weeks? They say “No” to reception,’ Dr Warby said.
‘Then to the doctor, they go “Oh, I’ve had this cough”.
‘You get told two or three times a day, “There’s no COVID here”; “I know my body, it’s not COVID, it’s my usual hay fever” or “I just have asthma”.’
Dr Warby says that being lied to by a patient not only compromises the doctor–patient relationship, but can also be ‘traumatising’ for GPs given the personal and professional implications of being named a hotspot.
‘If you’ve got a five-doctor practice, seeing 40 a day per person, that’s 1000 patient contacts per week that won’t get done,’ she said. ‘In Sydney, that’s all the vaccinations and preventive care that is lost.’
Dr Sekhon and his staff have had similar experiences with patients hiding information about their respiratory symptoms.
‘It has happened,’ he said. ‘The patients, they come with another problem and then they throw the line “Oh by the way, while I’m here, can you check my throat? I’ve been having this and this”.
‘We try and now examine people … in a different room; we try and sterilise, the ventilation is always going, every evening the girls do all they can to clean that room.
‘But this is unavoidable. You can take all the precautions, but if somebody unfortunately is mischievous, malicious, and we have people from all walks of life, there’s not much you can do about it.’
Dr Warby believes mixed messaging hasn’t helped the situation.
She says a letter sent to GPs by Queensland Chief Health Officer Jeanette Young in March, asking doctors to see patients with respiratory symptoms face-to-face due to hospital emergency departments being swamped, added to the confusion.
All the while, Dr Warby says uncertainty around PPE guidelines and a lack of fit-testing, as well as limited access to the National Medical Stockpile has left many GPs inadequately protected from risks of infection.
‘I still have my N95 that I bought from Bunnings last year because we can’t get any,’ she said.
‘If you’re looking at $5 or whatever it is a mask, are you going to mask up for every patient or, like us, potentially wear the same surgical mask for a couple of days because we got 10 delivered in six months at the start of all of this last year?
‘You can’t really, as a general practice, wear that cost of all of that stuff. That was part of the idea of respiratory clinics – but I don’t know if respiratory clinics were ever really well advertised to people.
‘I know that a lot of them disappeared, for example, in country towns where three months ago [they were] packed up and that was over, and then everyone had to go to the hospital instead.’
Dr Sekhon agrees the costs add up, and says he now understands what it means to be named a hotspot.
‘I spoke to the practice manager of that [radiology] firm and they had to spend easily around $4000–5000 just for deep cleaning, and they have to be out of action for 14 days,’ he said. ‘You lose obviously a lot of your income – and don’t forget, you still have to pay the staff and everything.’
Dr Sekhon says GPs need to know that they will be supported if they find themselves in that position.
‘There has to be some sort of an assistance,’ he said. 
‘Any business which goes out of action for two weeks and still has to pay the staff? I think government has some responsibility.’
Dr Warby says the lack of support has led to GPs feeling ‘dispensable’, and that there is a real need for ‘top-down leadership’.
‘We shouldn’t go to work feeling … the threat of shutting down, the threat of ending up on the news, the threat of being that GP – the one who’s spread it, the threat of bringing it home to your family, the threat of getting it yourself,’ she said.
‘All of that, and then someone is just like “Oh, I know I work at the airport, but it’s just the sniffles”.
‘We’re probably, especially in Queensland, testing a third of people who would actually qualify for testing. So you always have this sense you’re just skating by the skin of your teeth and it’ll blow up.’
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COVID-19 exposure site fit-testing general practice hotspot PPE triage


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Dr Clare Keogh   19/07/2021 10:11:00 PM

A daily frustration in general practice. If I had a dollar for every time someone told me that "they know they don't have COVID - it's just a cold" ...

Dr Dhara Prathmesh Contractor   20/07/2021 6:51:55 AM

True facts. Nice narrative expressing current day to day struggles in this pandemic. Cannot agree any more.

Dr Nicholas A. Cooper   20/07/2021 7:15:23 AM

We have recently had issues where patients have refused to wear a mask citing mask exemption due to a medical issue. On one occasion they made such a fuss that we called the Police who unfortunately reinforced the patients right not to wear a mask. Given what has happened in Melbourne this could put the whole surgery at risk as well as vulnerable patients in the waiting room.

Dr Nicholas A. Cooper   20/07/2021 7:20:15 AM

We have recently had issues where patients have refused to wear a mask citing mask exemption due to a medical issue. On one occasion they made such a fuss that we called the Police who unfortunately reinforced the patients right not to wear a mask. Given what has happened in Melbourne this could put the whole surgery at risk as well as vulnerable patients in the waiting room.

Dr Jeanine Suzanne McMullan   20/07/2021 9:00:55 AM

All of this. All the time. Attractive career for part time working woman with young kids?
Where is the Government GP Industry support package?

Dr Mohammed Iqbal Meeran   20/07/2021 9:17:37 AM

Heart goes out to the practices and their staff, hope everyone is safe and ok

Dr Raymond Weng Yat Yeow   20/07/2021 10:48:13 AM

Apart from vaccinations, our clinic has gone to almost 100pc telehealth.

Dr Omar Muwafak Mohamad Wafek   20/07/2021 5:40:09 PM

Dr Joshi, what you said is very true

Dr Adrian Neil Ellis   22/07/2021 9:18:49 AM

I had a repeat offender this week. Late last year he came for a full skin check after having a covid swab earlier that day. Then this week, as putting his stuff on the bedside chair to get sebaceous cyst removed, puts down his box of codral. ‘It’s just a runny nose doc!” It’s just a matter of time.

Dr Shireen Teves Macabulos   22/07/2021 11:28:58 AM

Dr Tammra Warby, everything you said resonates with me, and certainly with every other GP who has read this article.