COVID-19: A Medical Student Off the Front Line

Walking through the doors of the general practice surgery triggers emotions that I would not expect when on medical student placement: fear, nervousness and excitement!

Today marks the fifth week that I have been on my GP rotation. Over the course of these weeks the Coronavirus pandemic has evolved. The nationwide attitude is reflected by patients and staff here; from irony and cynicism to genuine fear. The waiting room is remarkably quiet, there are only two patients picking at their nails anxiously; a startling contrast to the usual hustle and bustle of this buzzing practice. I try to enter Room 3 but am immediately sent to get personal protective equipment: a mask and apron. I was expecting to have to wear such items when on my elective in countries with tuberculosis and haemorrhagic fever, not sitting in a general practice in West Yorkshire!

After the first patient leaves, there are no more, only phone triage consultations; the doctor calls patients and decides whether they need to come into the practice or if they can be managed from home. A mother is told to bring her 5-year old with suspected tonsillitis into the practice. Young children are going to have to be seen by a doctor and so it seems wasteful to even have this telephone conversation. The doctor explains that calling allows better organisation of patient appointment times. Those with long-term respiratory conditions who would be extremely vulnerable to a coronavirus infection should be brought in together at a separate time to those who are likely to be carrying it.

Next, the doctor phones a patient who is newly depressed. The doctor asks screening questions about thoughts of suicide and self-harm. This is difficult enough over the phone but this GP surgery is currently going under reconstruction so there is the added complication of a drill in the background. It is so difficult for the doctor to sound empathetic and caring whilst shouting down the phone.

A patient is called who has coronavirus like symptoms, whose husband tested negative for the virus. The doctor asks about cough, shortness of breath and fevers. The patient has wheeze like symptoms so the doctor explains she will have to see her. Despite her husband’s negative test result for Covid-19, this patient may be infected. It seems counterintuitive to bring her in as she may infect others, but the doctor needs to examine her and decide the best treatment option for her.

There are patients taking disease-modifying antirheumatic drugs (DMARDs) and chemotherapy who have to come to appointments for reviews and blood tests. These patients are immunocompromised and a Covid-19 infection could be fatal. There are no guidelines about how to manage these patients. Similarly, if patients need an X-Ray for a respiratory condition they will be sent into hospital; their risk of infection will be massively increased and it is those with lung problems who would be worst affected by Covid-19.

The doctor exudes frustration with the lack of information and guidance. There have been no meetings with the Clinical Commissioning Group or local Public Health England. This practice is trying to take a sensible approach but are essentially improvising. It is striking how the staff at the practice and across the NHS are selflessly risking their own health for the majority and are remaining calm in the face of the unknown.

Because of the coronavirus pandemic, I am now signed off my GP rotation and cannot help feeling like I should be doing more to help. Perhaps medical students could be trained to phone the patients and triage their appointments, a document could be created screening for red flag symptoms for different medical conditions. Or perhaps a service could be set up where the public can call medical students for reassurance, if they still feel anxious after reading about Coronavirus online. As I walk out of the practice I realise that my experience of GP was definitely extraordinary and was absolutely fantastic. But I can’t help feeling that sending me home to do nothing is not the best use of resources.

Rosie Solomon