Running a general practice during a pandemic

Evelyn Lewin

1/06/2021 2:31:32 PM

When the latest Victorian lockdown was announced, Dr Toai Phan’s heart sank.

Woman in face mask in waiting room
Patients were triaged before they were seen, to reduce the risk of transmission.

The Melbourne GP told newsGP he is well-accustomed to dealing with COVID-19 outbreaks.
During 2020, Dr Phan’s local area – Hallam, south-east of Melbourne – was twice declared a hotspot.
On both of those occasions, Dr Phan and his staff members were all tested for COVID and isolated until their results came back negative.
The entire clinic needed to be swabbed another time, too. That is, when the registrar at the clinic returned a positive test.
‘It happened in about April or May last year, during the first wave,’ Dr Phan said.
‘It was a very apprehensive and anxious [time].’
Naturally, Dr Phan was concerned for the welfare of his registrar. But he was also concerned about what the positive result meant for himself, his staff and everyone’s family members, and whether further staff members would also test positive for COVID.
He tried to keep a brave face for his employees.
‘Obviously, I had to still keep it together because there’s a lot of staff,’ Dr Phan said.
The registrar had not worked the day she tested positive, but she had worked the previous day. At the time, contact tracers were unable to determine where she caught COVID.
‘I’m sure it was from a patient,’ Dr Phan said. ‘We just don’t know which one.’
As soon as Dr Phan received a call from the registrar notifying him of her positive result, he realised his clinic would have to run differently.
‘Immediately after that we had to think about how we could prevent [further transmission],’ he said. ‘We had to rethink how we moved around within that practice.’

Dr Toai Phan’s registrar caught COVID-19 at work in early 2020.
The clinic underwent a deep forensic clean, but staff were back at work the next day. Although the clinic was practising appropriate hand hygiene, social distancing and the wearing of face masks, staff members still all shared the same space.
‘We actually then decided that all the doctors would just stay in their room the whole [day],’ Dr Phan said.
That included having lunch in their own room and not mingling with other staff at any other time.
While the GPs spent their days confined to their own room, nurses also were not allowed to mix with non-clinical staff, such as receptionists.
‘So if one person got sick, [we] didn’t all become close contacts,’ Dr Phan said.
Patients who were symptomatic were advised to wait in their car to be seen, and GPs who attended to them wore full PPE. Other measures were introduced to reduce transmission risk.
Patients were no longer invited to wait in the waiting room, but were instead advised to wait outside the clinic until their appointment. They were also temperature-checked upon arrival, and staff wore gloves and face masks when examining patients.
‘It was very tense,’ Dr Phan said. ‘It was very challenging.
‘After a while, patients lost patience with it all.’
As the number of COVID cases continued to climb last year, anxiety levels among staff members at Dr Phan’s clinic also skyrocketed. The practice owners brought in measures in an attempt to manage stress levels, such as promoting meditation at work and bringing in plants to brighten up the waiting room.
During that turbulent period, three staff members moved interstate, partly because they no longer wanted to live in the strict lockdown rules in Victoria.
There was a mixed reaction from GPs towards working in a potentially risky environment.
‘What I found interesting was the younger doctors and the registrars were much more [keen] to do telehealth and avoid the clinical contact,’ Dr Phan said.
Meanwhile, the ‘more experienced doctors’ felt more comfortable continuing to see patients face-to-face.
‘I’m not sure why that was. That was just the trend I found in our practice,’ he said.
Despite these challenges, working during a pandemic has been a rewarding experience for Dr Phan.
‘It felt like it reinforced why I went on to do this in the first place,’ he said. ‘It is about caring and looking after the community.
‘When pandemics occur, it becomes a much bigger thing than just one-to-one with that patient in front of you, and you look at all these things you never had to think about like … infectious risks and community issues. You do take a much broader view.
‘When you take stock of it, it does make you reflect on what it means to be a medico and it does make you think about general practice and medicine in general.
‘It reinforced why I did medicine in the first place. It certainly helped reinforce why we’re needed and why it’s important to have people there at the coalface.’
Dr Phan has been taken aback by the level of appreciation he has received from the community.
‘I certainly got a lot of “thank yous” from random people,’ he said.
‘You get a real sense of appreciation. You always got appreciation from the patient, but from the general public, it does sort of make you feel validated for the effort.’
Dr Phan would like that gratitude to extend to medical support staff, such as receptionists, who have also played a key role during the pandemic but who may not receive the same level of appreciation.
‘People talk about the doctors and the nurses, but there’s a lot of other support staff that make it happen and they don’t get the same credit or appreciation,’ he said.
While the anxiety among his staff is rising again with the latest outbreak, there has been a silver lining this time.
‘Having the rollout of the vaccine, which we’re also doing at the practice in some ways,’ he said. ‘The outbreaks are starting to give people motivation to get vaccinated.
‘Our vaccine clinic is full-up all the time, at least that’s a … positive to come out if it.
‘There’s more hope. That’s one thing that we lacked a bit at the beginning.’
Log in below to join the conversation.

burnout COVID-19 pandemic response risk minimisation

newsGP weekly poll Would the reintroduction of MBS items for GPs to trace and report on electrocardiogram (ECGs) be beneficial to patients?

newsGP weekly poll Would the reintroduction of MBS items for GPs to trace and report on electrocardiogram (ECGs) be beneficial to patients?



Login to comment