Placement in the time of COVID-19

By Meghan Taylor

I am currently on a general practice placement in regional Victoria. This is my experience of placement in the time of COVID-19…

I remember weeks ago, the discussion started with toilet paper, as the panic buying started around Australia. Patients would come in and make comments like “What’s going on with everyone buying toilet paper?”, “Does this coronavirus cause the runs?”, “Really shows how worried people are to not be able to wipe their bums”.

I recall seeing my practice manager setting up a whiteboard with information about COVID-19 at the entrance to our clinic. When I complimented him on it, he replied: “We’ve got to look like we’re doing something”.

Patients coming in for unrelated reasons would end their consults asking a COVID related question that had been playing on their mind. Perhaps wanting their trusting doctors’ reassurance… “How serious do you think this coronavirus thing is?”, “Should I be staying at home?”, “Should I stop visiting my grandmother in her nursing home?”. Difficult questions to answer and predict. Answers that could profoundly impact people’s lives and outlook. It’s challenging to manage someone else’s anxiety and uncertainty, when you have no more certainty yourself.

Over the coming weeks, we watched the numbers rise. The nursing and practice manager busied themselves trying to develop new processes for how reception staff work, screen patients and how things are cleaned. They put together testing kits for the doctors to take out to the carpark, while a designated fever clinic was being established.

Masks were put out for anyone experiencing respiratory symptoms. The clinic’s supply was almost depleted in two days, with people either being over-cautious or just stashing one away as masks couldn’t be found anywhere in town.

There was a lot of uncertainty around whether our placements would continue. A lot of metropolitan placements had been called off. By the Easter long weekend, the university had put in place a two week pause on all placements for my year level, with the exception of some select general practice placements (including my own). The uncertainty was challenging, particularly when you are within the context of heightened anxiety amongst your patients, colleagues and society overall. I felt I was always waiting for an email to come through informing me of another change.

We were told if any of the clinics within our area pulled out, all students would be pulled off placement. Then one pulled out and nothing changed. Another pulled out and we were still on placement. We were eventually told our placements were stable and would continue. It was a relief to hear.

I took a week off as I had mild cold like symptoms, following government and university advice. I came back to the clinic the next week and sat in my assigned room, readying myself for the day. Shortly after the practice manager came in and said “You’ll have to sit in with a different doctor today, Dr … has to self-isolate for two weeks after been exposed to a patient that tested positive to COVID”.

It turns out my supervising doctor had been called to urgent care for a patient presenting with abdominal pain. He took his history and examined him without wearing any PPE. He had become febrile by the time the next set of vital signs were performed. It was established he had significant recent interstate travel, and was tested for COVID-19, despite being outside of the official testing guidelines. His result returned positive a couple of days later. The first within the community.

The following weeks were quieter, the waiting room no longer overflowing. The waiting list no longer overwhelming. It felt almost like the calm before the storm. Everyone was hypervigilant, on alert. When I farewelled the nursing staff at the end of the day, they’d say “Make sure you have a shower when you get home”.

We almost felt like we were seeing the wrong people. A 90-year-old came in seemingly just for a chat – I wanted to push him out the door and tell him to stay home. On the other end of the spectrum, a 60-year-old presented to the urgent care centre with acute kidney failure after seven days at home vomiting. You begin to worry that some people are staying at home and not getting the treatment they need.

I saw workers whose employers wanted us to clear them of COVID-19, because they’d come to work with a cough. But how do you know if they don’t meet the testing criteria?

When the government announced it wanted everyone to get their flu vaccine, it was weeks before the supply of flu vaccines was scheduled to be delivered at GP clinics. All of a sudden everyone wants their flu shot but we have none. Flu vaccine stocks started to dribble into the clinic, 50 vaccines at a time, running out in one or two days. I jab every second patient with their flu shot.

I had one patient that asked for the COVID-19 vaccine. I explained that there is currently no vaccine available, which is why we have to stay at home. He seemed shocked.

The storm has thus far not eventuated. We have been lucky. But the uncertainty remains. My anxiety and hypervigilance has not settled. By this stage, I’m 16 weeks into the semester and looking forward to a break. Sadly, I won’t be travelling to Japan in the break as planned, I’ll be staying at home.