Every month, I urgently referred a dozen patients to the hospital. Where are they now? Are they dying at home? [LETTER TO MEDTvoiLokony]

A letter came to our editorial office – touching and very sincere. Its author is a family doctor from Poznań, who has daily contact with patients belonging to the clinic where he works. Or rather – he had contact, because the patients, terrified of the pandemic, completely disappeared from the clinic. “I believe that more deaths are now generated by the lack of medical care for the rest of those suffering from diseases other than the coronavirus. They are killed by fear and the absurd behavior of the government »- writes the author of the letter.

1. «The isolation effect of all people, empty streets, a flood of media information, legal confusion, all these constant exacerbations and terrible reports from, for example, Italy caused the patients to shut themselves – literally – on four triggers at home. As if they did not exist »- writes the author of the letter
2. He also points out that every month he received at least a dozen patients who required referral to the hospital, often immediately
3. For several weeks now, patients have not come to GPs at all, and the clinics are empty
4. «Have everyone recovered? No, I think that these – especially elderly patients – are either just dying at home in silence, or they will suffer a serious damage to their health which will not only worsen their health, it will also significantly shorten their lives, there will also be more invalids and the disabled »- writes the author of the letter

Healthcare during the coronavirus epidemic

“I am writing to you with a request, or rather an appeal, not only to the elderly and sick, but mainly to politicians. I am a doctor, an internal medicine specialist, I have worked in a voivodship specialist hospital, a poviat hospital, SORz-e and other medical institutions. Currently, I also work – due to the temporary life situation – in the clinic (POZ), as the so-called family doctor, in one of the big cities in western Poland.

Observing what is happening, it is impossible to conclude that the Polish crisis management system has not only lost its mind, but this deficit is still getting worse. Watching the next absurd prohibitions and orders, you can only wring your hands.

I was inspired to write a letter to you by a short article, probably prof. Dudek on your portal, which quite cursely warns that patients come to hospitals too late with severe exacerbations of diseases, including the heart, and do not come to the hospital because they are afraid of the virus.

1. Prof. Dariusz Dudek: we are threatened with a rapid number of deaths caused by diseases other than COVID-19

I would like to detail this alarm a bit and at least a little closer to the scale of the problem, which in my opinion, if not longer, will become more important than the coronavirus itself and will bring more – certainly – victims than those caused by COVID-19.

Knowing the professor’s point of view – I have been working on the heaviest front line for practically the last decade – I know what he is talking about, because during this time I myself have been receiving sick people sent from outpatient clinics (i.e. family clinics) on the emergency room (i.e. family clinics) and it was often immediately obvious that which patients waited too long to see their doctor. Thus, treatment will be much more difficult and risky than if they had applied earlier.

Patients? Closed with four triggers

Now, accepting the sick as a family doctor, I myself send patients to my colleagues from the hospitals who are on the front lines. And here comes the problem, because I don’t send them. Why? Because I don’t have any applications. For the first week or two, the situation was unobtrusive and understandable, now it is already terrifying. About 10 patients are enrolled in our clinic, and they are served by several doctors, who see them in parallel or in shifts. Each day of work is about 80-130 patients, coming in person (depending on the season and seasonality of the disease), plus correspondence services such as extending prescriptions, which is often performed without the presence of the patient.

The assumption during the pandemic was that the clinics switch to the “tele” mode, which is what they can do over the phone – medical advice, some medications, etc. And those cases that are urgent or require examination of the patient proceed normally, i.e. the patient goes to to the clinic and the visit goes as usual, only in protective gear.

Patients were informed about it and they know what and how.

Not a single sick person

Unfortunately, the isolation effect of all people, empty streets, a flood of media information, legal confusion, all these constant exacerbations and terrible reports, e.g. from Italy, caused the patients to shut themselves – literally – on four triggers at home. As if they didn’t exist.

Before Christmas, for several days in a row I did not have a single – this is important – NOT ONE – report of a deterioration of my health or a question about disturbing symptoms, which would be accompanied by a telephone question: “is it dangerous doctor?”, “What to do with it”?

Some statistics.

Every month, as a family doctor at the NHF clinic, I had – almost always, every month – several hypertensive oranges (high blood pressure, e.g. 220 / 100mmHg) that were life-threatening, several exacerbations of circulatory failure and symptoms of ischemic heart disease, several (more often a dozen) pneumonia , several exacerbations of chronic obstructive pulmonary disease, acute limb ischemia, unconsciousness of unknown origin, monthly diagnoses from at least one to even several type 2 diabetes de novo (i.e. first diagnoses), of which 1-2 cases required hospital intervention due to on symptoms. I could go on like that.

Out of the entire set of reports – to me, as a family doctor – about 200-250 (within a month) of them required medical intervention, in the sense of introducing treatment or modifying the current one. Of these 200-250 cases, about 5-10 required urgent specialist consultation, most often in a hospital, 4-5 cases required urgent admission to hospital – urgent, that is, immediately.

Read: “Yesterday night I went to the infectious ward 12 times”. Paramedics reveal what work in an ambulance looks like now

I am writing this letter from an empty clinic

I am writing a letter to you from my clinic, I have time for this, as there are practically no reports. As usual, we accepted one patient for 7-12 minutes, so throughout the time of writing this letter, there was literally one phone call to issue a prescription for a drug that the patient forgot. Before Easter, for a week I had maybe one question about my blood pressure rising and one about coughing, mostly from middle-aged people.

What about the older ones? Those who were our main patients before? Zero… ZERO submissions.

For the last 40 days I have not had a single serious report, maybe 4-5 telephone interventions in which I have modified the drugs – not very serious – and maybe two (TWO!) Personal visits of patients, one is a bruise with suspected fracture, the other changes in the lungs requiring urgent diagnostics – suspicion of lung cancer.

What about the rest? Where are these newly diagnosed – monthly – diabetes? Where’s the pneumonia? Where are the impending exacerbations of circulatory failure? Where are the emergencies suspected of having a stroke or heart attack?

Patients? They are just dying in silence around the houses

Had everyone recovered? No, I think that these – especially elderly patients – are either just dying at home in silence, or they will suffer severe damage to their health which will not only worsen their health, but also significantly shorten their lives, there will also be more and more disabled and disabled people. A person with untreated very high arterial pressure may end up with a stroke at any time, and as a result, for example, with paresis or paralysis of, for example, one half of the body.

How many older people will die from pneumonia? For the last 40 days I have not treated a single one (pneumonia), because there were no reports, and according to monthly statistics, there should be at least a few, up to a dozen or so. Especially since the pandemic in Poland occurred in March and April, which are intense months when it comes to pneumonia and infections.

Of course, the reader may think: okay, that’s a few cases or a dozen. Well, no, the scale makes the difference. Assuming the statistical data that in my voivodeship there is one family doctor – like me – for approx. 1750 inhabitants, and my city has approx. in the city, i.e. about 500 family doctors.

Read: Coronavirus in Poland. What is the situation in oncology?

Now let’s multiply the number of cases (these few). So 5 (cases per month that require immediate hospital attention) multiplied by 285 doctors, and we get over 1400 cases that have a high probability of death if they are not admitted to the hospital. Now let’s take pneumonia, which in the elderly requires urgent antibiotic treatment. Let’s optimistically assume that there will be 15 of them per month for one family doctor, so 285 family doctors times 15 pneumonia gives 4 pneumonia without treatment.

The sick are killed by fear and absurd government decisions

This can be counted further, giving the result of approximately 50 treatment failures and leaving a patient with the disease without medical care in a city of half a million, of which approximately 000 cases require immediate hospital care and a high risk of death. These 1400 patients also include those seriously ill, with exacerbations of heart and circulatory diseases mentioned by Professor Dudek.

Now the question: how does this relate to the deaths due to the coronavirus, to these less than 400 cases? Personally, I believe that more deaths are currently generated by the lack of medical care for the rest of those suffering from diseases other than the coronavirus. They are killed by fear and absurd government behavior.

Increasingly inconsistent with the logic of the recommendations of politicians (politicians, because experts in the fields seem not to listen to them at all), will aggravate this problem.

Read: Operation during the coronavirus outbreak. When should the procedure be canceled and when it cannot be canceled?

It is forbidden to go to the forest, so people crowd on the paved sidewalks

From a family doctor’s point of view, I see a lot of people asking for sedatives and more and more asking for painkillers, because sitting at home has a cruelly bad effect on the locomotor system, any degeneration, etc.

The absurdities of the recommendations begin to resemble tragicomedy. Recently, discounters were ordered to enter the store only with large metal baskets taken from pre-store car parks. This is harmful nonsense that can spread the infection. Unfortunately, the management of discount stores did not understand that when I come to the store with my own bag, it is safer, because I take the products with my hands in disposable gloves into my own bag from the shelf, there is no transmission.

When I am forced to take a large bin from the parking lot, I have to first grab the cart that has probably been pushing by a thousand people a day and transfer the bacteria from the handle of the cart onto my hands, whether they are wearing gloves or not. Then I will transfer these microbes of a thousand people to products that I will take off the shelf, and then I will take them home to the whole family on the products. Where’s the logic here? Later it turned out that the metal baskets are there for some detector to count the shop’s customers … the hands are dropping.

Absurdities follow absurdities

How many people really died as a result of the pandemic, we will probably find out in a few months, when we compare the death statistics from the previous years to the months of the pandemic. Most of the deaths I think will be due to absurd crisis management rather than the virus itself, you can be sure of it.

My appeal is directed mainly to the children of the elderly and the neighborhood helpers to find out what “REALLY” is going to their parents, neighbors, older friends, because it is certainly not as rosy as they say on the phone.

LETTER TO MEDTvoiLokony – read other stories:

1. “I’m scared. I’m starting to fear the virus more than the cancer »
2. “I am 33 years old and pregnant, which is at risk”
3. Health paralysis? «The doctor will not do an ultrasound using the telephone receiver»
4. “I do not want to expose myself to people who have to buy pants during an epidemic”
5. “Doctors quarantine, politicians test for coronavirus right away”

Have a question about the coronavirus? Send them to the following address: [email protected]. You will find a daily updated list of answers HERE: Coronavirus – frequently asked questions and answers.