Caring Without Touching

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Gavin Francis, a doctor in Edinburgh, Scotland, writes candidly for The Guardian about his life as a general practitioner (GP) being turned upside down by COVID-19. While his GP training emphasized the importance of building empathy and rapport, now he stays as far from a patient as possible until the moment of having to examine them — if they meet in person at all — with the number of actual face-to-face encounters with patients dropping by 90%.

“Could you stand up for me?” I asked. We shuffled awkwardly on the small landing in a doleful dance. He turned his back and I lifted his pyjamas to place my stethoscope on his back. The sound of air through his lungs was accompanied by a quiet hissing sound, like sizzling fat. The sound of pneumonia. In his case, pneumonia probably caused by Covid-19.

“I’m going outside, then I’ll phone you about what happens next,” I told him. I picked up the clear bag with my stethoscope, oxygen sensor and thermometer, and stepped out, trying to hold central to my awareness and every action that there was virus on the walls, the door handle, my gloves and all my equipment.

Out on the doorstep I gulped down the fresh air, then it was back to the rigmarole: topmost layer of gloves off and into a waste bag. Still wearing my underlayer of gloves, I took a chloride wipe and began to clean all the equipment – stethoscope, oxygen sensor, thermometer – and placed them into yet another clear plastic bag, ready for the next patient. The wipe went into the waste, then my apron. Next it was the visor’s turn to get cleaned, and afterwards I placed it on the ground to dry. Then undergloves off, mask off, the clinical waste bag tied off and sealed, and back into the car.

The lockdown in Scotland has caused the number of COVID-19 cases to fall. However, Francis points out that doctors are noticing a different type of problem.

It’s clear that though the lockdown has slashed transmission, it is provoking a silent epidemic of despair. Panic attacks, sleeplessness and plunging moods are all difficulties GPs are encountering daily – tough conversations to have at the best of times, but even tougher on the phone. Within our area of the city, we already know of suicides triggered by bankruptcies and business closures; and of marriages breaking down. Alcohol-induced injuries are up, as are injuries from assaults. Between 23 March and 12 April, there were 16 deaths from domestic violence in the UK – more than triple the still-shocking figure from last year. A police officer friend told me that domestic abuse support lines were experiencing a 30-40% increase in traffic. Samaritans and Childline, too, were receiving high volumes of calls. A domestic abuse hotline for NHS workers had been inaugurated – intended to support both health workers at risk, and to offer advice should they suspect patients of being abused. When I check routine blood tests on my patients, I have been seeing new flares of liver irritation, which suggest rising levels of alcoholism.

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