“Living with uncertainty” is a term general practitioners learn in training. It describes a type of resilience, a calm assessment and realistic planning.
At the time of writing we are in a kind of phony war. We have not seen the enemy yet, but we expect to hear bombers overhead at any moment.
After our years in training and practice, doctors have seen most conditions, and are confident we can diagnose and manage them. This time we only know what we have read, and much of that is confusing. Maybe it is hiding in plain sight, and we might have it ourselves, with only a sniff to show for it.
Or it could be masquerading as pneumonia, and we have not spotted it.
For the past few weeks you hear “go to your GP” on the television and the radio. It should of course be “contact your GP”. GPs can arrange a test, but not do it ourselves.
It is clear that a crowded waiting room is to be avoided. Anyone who is used to going to the GP is familiar with the person who brings three small unruly children along with them, presumably for the fun of it. They could be carrying Covid-19 with no symptoms at all.
We want to protect our flock – the kind old gentleman with the failing heart, the young mother with diabetes. People with chronic conditions need to be seen without putting their lives at risk.
Also, GPs were at full capacity before this emergency. The average GP in Ireland is well on in years, and might not do well if they caught it themselves. In any case, if they recovered well, if even a small number were in isolation, it would throw a huge burden on the health service. So we have had to dramatically change the way we work.
We now put on full protective gear. The front door is closed and plastered with warning posters. The waiting room is locked. All the rooms are repeatedly sterilised as well as we can. We sit at the computer and triage all the calls, using algorithms and flow charts. “Do you have a temperature? Is it a dry cough? It goes against the grain to work like this; to prescribe antibiotics over the phone, to treat a depressed patient without face-to-face contact, to reassure without having touched.
There is always one, though.
A businessman marched up to the door and demanded a full check-up and blood tests. When he was informed that we were on lockdown, and the lab was only doing emergencies anyway, he angrily told us that the whole country was over-reacting.
At the back of our minds is the thought that a great wave of work is hanging, suspended, and when all this is over the blood sugars and hernias will have to be managed. At least if the kids are at home, the usual number of illnesses, the colds and rashes and mumps, should fall dramatically.
The protective gear has a plastic smell reminiscent of operating theatres – we had forgotten about that. Many a doctor remembers stints in developing countries in our youth ,when we were used to working clad like this.
Information is vital. The HSE website is our official channel. The Irish College of General Practice is playing a blinder, with constant advice and updates. Our WhatsApp groups trade the latest news at a frenzied rate. We want to act in unison, on best advice.
Everyone asks us what is happening, worried relatives ring us up.
It is exhausting, working like this, typing and talking down the phone and evaluating risk – it far harder than the daily job of normal consulting.
There is a reassuring email from Rita Doyle, the president of the Medical Council acknowledging we are doing our best, in the inbox.
It means a lot.
I talk to a public health doctor on the phone. I ask did she have this in mind when she chose that speciality. We have a laugh that neither of us signed on for this. She is exhausted, but she still has a sense of humour.
I go on my local radio slot on Tipp FM every day and advise about washing hands and social distancing and if the World Health Organisation says do something, just do it.
We are all in this together – living with uncertainty.
There’s a war on, you know.