View from the ground, by Dr Sandesh Gulhane
I am scared. That is not a normal statement from a doctor of 14 years, who works across general practice and A&E, and as The Queen’s Park football club doctor. I am used to seeing acute problems, and working under high stress and time pressure, but the coronavirus crisis is something else. It is not the risk that this disease poses to me, but rather the risk that I could pass it to my pregnant wife or unborn child, parents or loved ones who might die because of me. Being a frontline GP puts me squarely in the firing line of getting this and thus me passing it on.
I live with my pregnant wife and 6-year-old child. Being pregnant, my wife is in the high-risk group and should be stringent in following social distancing measures—but as a GP herself is at risk purely by going to work, which led to the agonising decision to go on maternity leave a few weeks early. I am sure that I will get the virus at some point, but I want to do everything I can to not pass it on to my wife, child, or unborn. We have no underlying medical issues and so feel confident that we will survive the virus, but what potential harm could it do to the developing baby? We do not know, even though there have not been reported signs of harm yet. But healthcare workers are dying, including a pregnant nurse. I have been distancing myself from my family, sleeping in a different room, changing at the front door and immediately having a shower. I understand the evidence, but I must try as hard as possible to not pass anything on to my family.
I was not around as a doctor at the time of the last respiratory pandemic, but infamously it was chaotic as we were not prepared. We had no plan in place and were making up the rules as we went along. Following this, I thought plans had been drawn up and lessons learned, but in this crisis the problem is a lack of communication, I feel. We are simply not being told things quickly enough and I am relying on news outlets to find out the latest. Some local medical committees are excellent at speaking to their constituents, while others have become worryingly silent.
Initially we did not receive any personal protective equipment (PPE), and then we got surgical masks, gloves, and plastic aprons. The surgical masks had expired in 2016, but had a sticker placed over the top extending the expiry date to 2021. The Scottish Health Secretary said this was an error by the health boards, then we were told that each item was tested and safe for extended use but what are we to think? There was no form of communication explaining why this had happened.
We have discovered that the masks are only 80% effective, which was considered acceptable as GPs were not expected to be seeing patients with active disease. This has since changed as NHS 111 was overwhelmed—the British Medical Association (BMA) are saying we have inadequate PPE for what we are now being asked to do. There is a lack of PPE for many of my colleagues with single-use items being reused and communities trying to provide eye protection for GPs. We have been told as a nation to isolate for 14 days if a family member has symptoms, but some trusts are telling doctors to ignore this and come to work if asymptomatic, which contradicts the BMA advice. Retired doctors, many of whom are at increased risk or vulnerable, are being asked to return to work—yet we were told staff in these groups should not see patients with respiratory symptoms. Again, poor communication.
Am I being asked to put myself, and my family, at risk to help others and protect the public? I am sacrificing my family life by not hugging my wife and child, and eating and sleeping separately, but I am also a doctor who simply wants to help save people’s lives. I am aware that I could be at risk, but I struggle with having to put my family at risk. I struggle with having to do this when many members of the public are not listening to the advice to stay at home, but still expect me to look after them if they become ill.
I wonder if I am the only one scared, standing alone, having blown it out of proportion or if my fellow doctors also feel like this, but are too worried to speak up.
Dr Sandesh Gulhane
Queen’s Park Football Club doctor
Co-Chair for BMA GP trainees Subcommittee