GP doctor: soon we will not be able to see all patients in need

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Record numbers of infections have not yet translated into an increased number of hospitalizations of covid patients. This means that the siege will be survived not by hospitals, but by clinics. The situation is already very bad there. – The minister decided that we have reserves. In my opinion, he was wrong. In my practice, I have no reserves and I will not be able to accept some patients. We are really tired, stressed and we are less and less eager to come to work, afraid of what the day and the future will bring – says Anna Krzyszowska-Kamińska, a family medicine doctor from Wrocław.

1. More and more covid patients come to the clinic. According to the doctor, most of them are unvaccinated. – Testing themselves, not admitting infection until I take a picture of the chest and see interstitial pneumonia there
2. Bow. Anna Krzyszowska-Kamińska draws attention to the limited possibilities of diagnosis and treatment of patients infected with coronavirus in PHC: – If there is a top-down recommendation that PHC should deal with patients more strongly, I would like to have the tools to do it – she says
3. The doctor from Wrocław also refers to the government’s idea that the GP should physically examine it within 48 hours. from the detection of infection in patients 60+. – That’s bullshit. We’ve always tested those who required it, and now I will test those who are positive, even if they have almost no symptoms. It can turn you crazy
4. More information can be found on the Onet homepage

Paulina Wójtowicz, MedTvoiLokony: We have been observing a dynamic increase in the number of coronavirus infections for several days. What does the fifth wave look like from the perspective of primary health care physicians?

Bow. Anna Krzyszowska-Kamińska: It’s very hard. Lots of sickness and a mess. Patients perform the tests on their own, do not admit that they are positive and report to us when there is no improvement and their condition becomes more and more severe. The test is already negative then, and then the “stairs” begin, what to do with them. Yesterday and today most of the calls are requests for a PCR test or questions if you can come and have an antigen test at the clinic. Unfortunately, every second test is positive. On top of that: solid interest in the third dose of the COVID-19 vaccine and almost zero in the first.

What symptoms do patients report?

It depends on whether they are vaccinated or not. The vaccinated people have the classic symptoms of a cold: runny nose, sinuses, malaise, temperature elevated to 37 degrees with pennies, rarely higher. Two or three days and peace of mind. They usually spend the remaining few days of isolation on cleaning their homes.

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And the unvaccinated?

There is a big problem with them, because they are people with quite firm views, generally negative to everything, convinced that nothing bad will happen to them. They test themselves, don’t admit infection until I take a picture of the chest and see interstitial pneumonia there. Only then do they say they did have COVID-19, but nothing bad happened at first.

Then another problem starts because we prescribe them what we can, which is an inhaled steroid. Unfortunately, he is fully paid, which the minister did not mention on TV. Many patients do not really want to buy it, because it costs 70-80 PLN. They argue that people with asthma have it for pennies, and in their case “there is no indication to reimburse”. I do not know why the minister will not waive the refund and thus not allow the wider use of the drug.

The rest of the text below the video.

What, then, can doctors in primary health care treat COVID-19 patients?

What we are allowed to recommend to patients in the area is: an antipyretic drug, vitamin D, zinc, vitamin C and steroid inhalations, of course, if one of the main symptoms is a dry, tiring cough. Plus, reliable irrigation. On the spot, I can take a picture of the chest, which I do, but I no longer have the option of having a CT scan of the lungs. Unfortunately, there are no reliable data or recommendations for the use of amantadine or ivermectin.

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The second test that is unavailable at PHC is the determination of D-dimers. Coronavirus is prothrombotic in some people, so D-dimers are measured when a patient enters the hospital.

I work in a fairly wealthy neighborhood, so patients perform diagnostic tests privately without blinking an eye, but it shouldn’t be like that. If there is a top-down recommendation that primary health care should take more care of patients, then I would like to have the tools to do so. I am waiting for the minister’s next gesture that we are to buy oxygen cylinders and provide oxygen to patients at home, because oxygen therapy is also one of the recommended and basic forms of COVID-19 treatment. Since some kind of action is being imposed on us now, it can go further.

According to the new rules, doctors are required to examine patients over 60 years of age diagnosed with COVID-19. This test must be completed within 48 hours. from obtaining a positive PCR test result by the patient. How do you rate this recipe?

This is bullshit. Why should age be a criterion when choosing patient care? The examination in the first stage of the disease does not bring anything in, because at the beginning the viral infection is almost undetectable. What can we see there? A little red in the throat, auscultationally most patients are clear. Only when it becomes bacterially infected can I recognize bronchitis or pneumonia. Most often, interstitial pneumonia is not heard under a stethoscope. You can see it in the photo, although not always, but it will certainly be shown by computed tomography, which is what is not available in health care.

We’ve always tested those who required it, and now I will test those who are positive, even if they have almost no symptoms. It can turn you crazy. I must admit that we are appalled by this regulation, it disorganizes our work a lot. Until now, we have been able to decide for ourselves which patient requires our intervention, and this choice is not always so obvious. It’s not necessarily an 80-year-old patient. I was going to a 40-year-old boy with a huge neurosis. Twice on weekends, when he knew that no one would come to him, he landed at the SOR and was sent away because nothing like that happened. I knew that when I went to him, examined him, calm down, everything would be fine for the bank, so after work, after 18, I went to him and examined him.

1. Also read: Examination of an infected senior within 48 hours? Family doctor: “I wonder how the prime minister will handle it with doctors”

In theory, the doctor for home visits should set aside time within working hours, go to the sick person in the so-called “in the meantime”.

Only there is no lap time. We’ll start jerking it off from other patients’ visits. Now the doctor, who normally at He would go out on home visits on the 14th day, he would have to leave early to be on time with everyone. I am the owner of my practice, I leave my life and heart there, so I sometimes go to the patient after 18 p.m., but I cannot require this from doctors with whom I have a contract until 18 p.m.

Can’t be tested on the spot at the clinic?

If a patient calls me and says that there is no way to get to me, I have to go see him. And this is the whole trip. More than once, I went to a home visit disguised as an alien, to the delight of the people in the windows. I get out of the car, change my clothes, everyone is happy. I am not an ambulance, so I cannot park close to the patient, especially since we have a lot of ghetto-type housing estates, fenced, it is impossible to enter there without authorization. So I park where I can, sometimes in the parking lot of some hypermarket, and then I rush from there in a jumpsuit, like Santa Claus, through the estate. Chatter has a use.

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What is the organization of work and admitting patients in your clinic at present?

From 17 the practice is only open to confirmed covid patients. We end vaccinations, examinations, normal visits, non-covid patients should not, for their own safety, be in the clinic anymore, only positive patients enter. We divided our work so that by 12 o’clock we enroll patients without infection: for blood collection, other diagnostic tests, patients with diabetes, hypertension, sciatica, abdominal pain, etc.

Later they come increasingly infectious and are tested right at the entrance. We have set up a curtain for quick antigen tests. When it comes out positive, the person who tested, of course properly protected, examines the patient, measures the saturation, pressure, heart rate, collects a detailed interview and evaluates it. If the patient is in such a condition that he can safely return home, we send him there and ask him to come back around 18pm. – so that it can be cleaned and aired as soon as possible.

The forecasts of the fifth wave are not optimistic. The clinics will be full of covid patients. What about those who are negative and will need a doctor’s appointment? Will there be a place for them in such a busy schedule?

The government’s message is that covid patients are more important than others. I do not agree with that. In practice, if I do not accept someone and something happens to this patient, he will not drag the minister or the prime minister to the courts, but me. We are really tired, stressed and less and less eager to come to work, fearing what the day and the future will bring.

What do you think you can bring?

We will not be able to see all patients in need. It used to be that a good 30 percent. visits were absolutely unnecessary visits, we called them patronage visits. The patient was bored at home, he came to see what we look like. Now they are almost gone. Those who do not need it stopped visiting us, we are no longer a meeting place in the estate. There are those who need help and we will not be able to receive them all. I’m afraid about this. The minister decided that we have reserves. In my opinion, he was wrong. In my practice, I have no reserves and I will not be able to accept some patients, they will suffer a lot.

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