In the fourth wave, POZs will switch to teleporces only? Doctors answer

The number of coronavirus infections is increasing day by day – data from the Ministry of Health indicate, while the Delta variant has not yet fully shown what it can do. When the daily number of infections exceeds two thousand and population immunity is still lacking, the question arises whether we are in danger of a repeat of the fall. Patients fear that GP clinics will close their doors to them again and switch to telepaths only, which, while useful, are not the most effective method of treatment.

1. Dr. Katarzyna Śleziak-Barglik, head of the POZ clinic in Ruda Śląska: – I cannot imagine seeing patients only by phone. During the pandemic, I saw such advanced and advanced conditions as if the health care system was not working at all
2. Dr. Paweł Lewek, family doctor from the Le-Med clinic in Łódź: – I do not know a clinic that would operate mainly on the basis of telepaths. The vast majority work in hybrid mode
3. Dr. Anna Andrukajtis, family doctor from the POZ clinic in Pomerania on work in the fourth wave: – There will be no fear of admitting, for example, seniors, our regular patients, whose lifestyle and contacts we know. If a patient presents with an infection, we will protect ourselves and treat them as if they have COVID-19
4. The observations of Dr. Andrukajtis show that young people liked the teleporting the most. – It is completely different with the elderly – he says
5. More information can be found on the Onet homepage.

Teleporting, which we consider to be the legacy of the pandemic, was in operation earlier, and its implementation on a larger scale has accelerated the development of telemedicine as a thriving branch of medical services. The proof is the rapidly growing number of websites where doctors of all specialties are available just a few clicks away. However, technology cannot replace personal doctor-patient contact. Treatment is based on live advice, and many GPs worry that they are not recognizing their patients after long periods of telephone work.

Current status quo: POZs operate in hybrid mode

– Teleporady stopped being abused already in spring – says Dr. Paweł Lewek, family doctor from the Le-Med clinic in Łódź. – Interestingly, when, according to the order of the president of the National Health Fund, my clinic wanted to switch to direct advice only, we encountered resistance. Patients demanded that this form of contact should not be taken away from them, because they are leaving, because they have gotten used to it, because how can they now visit the clinic in person for milk for a child or for a prescription? Since everything was working so well and they could arrange so many things, they wanted to keep contacting us on the phone.

– However, I do not know a clinic that would operate mainly on the basis of teleporces – adds Dr. Lewek. – The vast majority work in hybrid mode. Whoever wants to come in person – comes, and whoever wants teleportation, and the doctor thinks that it is enough, can have it. I would leave this to the patient’s decision. Of course, if there is no suspicion of some kind of abuse, because when someone wants a monthly release on the basis of telephone advice, it raises doubts. However, when a patient known to the doctor needs to extend the medications, he should be allowed to obtain the prescription via teleportation. It is not a problem.

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– I cannot imagine admitting patients only by phone – says Dr. Katarzyna Śleziak-Barglik, head of the POZ clinic in Ruda Śląska. – During the pandemic, I saw such advanced and advanced diseases as if the health service was not working at all. Patients did not come for fear of infection, not knowing how their health was deteriorating. The solution itself is good, I call the patient for the reported need for teleportation, but also when I see, for example, inaccuracies in taking medications or I suspect that a drug has been lost … It is often the case that the patient really does not have to come in person. If I want a referral and I find it appropriate, I can write it out online. I have the luxury of seeing the patient’s results, and in the case of consultations with specialists in our clinic, also their entries.

– At the moment I work in four clinics, two remotely, but only because they are far away and I support my sick friend – adds Dr. Śleziak-Barglik. – There are fewer and fewer doctors, they are getting older and they also have health problems. I believe that we should work normally, because that’s what we got vaccinated for. However, I understand my friends, who have diseases at risk of more severe COVID-19 or cancer, that they are afraid, despite the full vaccination of contacts, which may lead to a deterioration of their health. Everyone is responsible for himself, and today in my home facility I had four telephone consultations (from 11 am to 18 pm) for a total of 38 patients. In the clinic where I was seeing until 10, I only had traditional advice. 25 people came and entered the office one by one.

– Registrars or nurses always ask when registering a patient if teleportation is enough – says Dr. Anna Andrukajtis, a family doctor from the POZ clinic in a 3 thousand. residents of a town in Pomerania. – If someone just wants a prescription or has a question, they choose teleportation. It is the patient who decides about the form of contact with the doctor. However, if something bothers me, I say that yes, we can talk to each other on the phone, but please come to the appointment in person.

When asked how he sees his work in autumn, Dr. Andrukajtis replies: – There will be no fear of admitting, for example, seniors, our regular patients, whose lifestyle and contacts we know. After all, as a family doctor, I know a lot about them. The feeling of security is greater now, so we will not limit ourselves to just teleportation. If a patient presents with an obvious infection, we will protect ourselves and treat them as if they have COVID-19.

Teleporting has its place in the practice of family physicians

Dr. Honorata Błaszczyk, family doctor and president of the Łódź Branch of the Provincial College of Family Physicians in Poland, has not yet had a patient suffering from COVID-19 since the beginning of the fourth wave, but in her clinic in September, two covid-positive people have already counted. During the summer holidays, few patients reported symptoms suggesting coronavirus infection, so a small number of tests were ordered. In September, the number of test referrals increased slightly, but there are still few infections.

– For now, we are working as we did before the outbreak of the pandemic – says Dr. Błaszczyk. – In the mode of direct contact with the patient. We use the sanitary regime all the time, which begins at the stage of receiving the visit. In our registration, the application is accepted by a medical worker, so the interview is already collected at this level and if the patient presents infectious symptoms, he will be scheduled after the end of admitting people who do not manifest such symptoms. For example, children for vaccinations are also arranged in a completely different manner. We strive to ensure that there are as few people as possible in the waiting room at the same time and that patients with obvious symptoms of respiratory or gastrointestinal tract infections do not mix with healthy ones. We normally carry out home, nursing and medical visits, as well as midwife’s visits.

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– At the same time, we place greater emphasis on maintaining sanitary rigor – adds Dr. Błaszczyk. – The medical staff work in protective clothing that is changed every day, we accept them in masks and we ask that patients also come in masks, and those with symptoms of respiratory system infection are examined in a separate office. If a patient who suspects COVID-19 calls, we give him teleportation, order a test and contact him only after receiving the result.

There is less teleporad, patients seem to miss personal contact, and Dr. Błaszczyk admits that doctors have similar feelings.

– We have even introduced such a procedure that if a patient asks for repeated medications, but has not been with us for at least six months, we invite him to visit – he says. – Especially patients with chronic diseases need to be monitored, so we want to see them to see if they are in good condition. It is not known how the future will turn out, it may turn out that there will be many more cases and we will again hear the recommendation “stay at home”. And there have been cases when a patient who was afraid to come, became unstable in his chronic diseases, I also notice an increased number of suspicions of cancer. Early oncological symptoms are very important and sometimes within two or three months the cancer is already advanced, so we need to be more alert.

“Young people liked the teleporting the most, they liked being able to call the doctor while working or driving,” says Dr. Andrukajtis. – However, it is completely different with the elderly, who do not always follow the doctor’s telephone explanations. Seniors prefer to come in person.

– In general, teleports make the work of a family doctor much easier and therefore they should stay forever – laughs Dr. Andrukajtis. – Thanks to them, I see 60 people a day, and if they all came in person, they would certainly not get to the office. The patient comes for one prescription, but he always remembers something … On the phone, patients are more specific. At the same time, it cannot be that I do not see some of my patients for so long that I do not recognize them.

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GPs admit that they have already gained some experience. In 2020, they did not know how to navigate in a completely unknown pandemic reality, now both doctors and patients are aware of COVID-19, they know what the alarm symptoms are (e.g. intensification of shortness of breath), they use a pulse oximeter. Patients also learn from their mistakes and know that the lack of contact with a doctor results in the worsening of chronic diseases or the emergence of new ones that require diagnosis.

– I think that the patient’s self-observation during a possible next lockdown will be more balanced – Dr. Blaszczyk suspects. – The patient will be less afraid because he knows what he can afford and when he should contact the doctor face to face.

“Limiting ourselves to teleportation is very difficult and we doctors felt it,” he says. – I’m talking about the difficulty of making a good diagnosis over the phone. Patients also felt it, because it often turned out that their words had been interpreted differently than they thought. It seems to me that these experiences will result in better contact, even in the event of a lockdown.

– If the doctor thinks that it is necessary to meet, the patient should not object – adds Dr. Lewek. – Of course, you can make a catalog of cases that a doctor should examine personally, but it would only be a kind of recommendation, because in medicine, rigid findings never work. For example, in a young child, the situation may change within hours; teleportation is fine at the beginning of the day, and in the evening the fever increases and must be seen at the clinic.

No privileges for the vaccinated

After the experiences of the previous months, everyone (regardless of their role in the doctor’s office) takes into account the drastic increase in the number of coronavirus infections from fall to spring 2022. If this happens, it is possible that clinics will switch to teleporting again. Unfortunately, the vaccinated people will not get any privileges. Family doctors declare that they will treat everyone who comes to them the same, although the computer system shows them who took the vaccine and who did not.

Dr. Paweł Lewek assumes that the division of patients into vaccinated and unvaccinated would not work and therefore will never be introduced.

– I think that Poles, also for historical reasons, are against any sort of segregation – he says. – Vaccination in this perspective is a plus for the patient, who significantly reduces his risk of hospitalization due to SARS-CoV-2 infection. Those who have not been vaccinated should take into account the fact that they may end up in a hospital, and if they are saved, they may face long rehabilitation.

– I will accept all of them personally, but in accordance with the principles of DDM – says Dr. Katarzyna Śleziak-Barglik. – I think that during the registration of fever patients, we will first arrange a teleportation, a possible coronavirus test, and then a personal visit, of course for a specific time.

– In my clinic, vaccinated patients do not have any privileges – explains Dr. Honorata Błaszczyk. – The same rules apply to everyone. The patient has to wear a mask and is subject to the same interview and management procedures, although we do have a large group of vaccinated patients, mainly seniors.

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Doctors remind that the information about the vaccination is reassuring for them in terms of the possibility of a severe course of COVID-19, but does not negate its diagnosis.

– It would be ideal if we, as a health service, were refreshed and rested, because then the immunity is better and the chances of getting sick are smaller, but this condition is unlikely to accompany this condition – notes Dr. Śleziak-Barglik. – I would also introduce common flu tests in primary health care. We would then know how to treat the patient at the beginning of the road. Such tests are already available, but unfortunately for a fee.

– Everyone who currently enters my office, I ask if he is already vaccinated against «covidka» – says Dr. Anna Andrukajtis.

GPs continue to encourage patients to take the vaccine, especially in young people, who have the lowest vaccination coverage.

– It would be good if the holiday carelessness turned into prudence, and parents thought about vaccinating their children (from the age of 12). Let’s not forget that we are still in the period of an epidemic and an increase in the number of infections is inevitable – reminds Dr. Błaszczyk. “And we have vaccine weapons, so it would be ignorant not to use them.” Unfortunately, it seems that a factor convincing to vaccinate skeptics is a severe illness of a member of the immediate family.

Dr. Śleziak-Barglik points out that teleporting for children in a certain age group was forbidden at all. He believes that some decisions of the ministry are not made wisely, although he realizes that they are driven by a fear of misdiagnosis and abuse of telephone advice in relation to children and, for example, people suspected of having cancer.

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