Be kind: GP receptionists are taking the heat with every policy update during COVID, vaccines included


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Lauren Ball, Griffith University; David Chua, Griffith University, and Katelyn Barnes, Griffith UniversityPhones are ringing off the hook at GP clinics with people desperate to know when and how they can be vaccinated against COVID-19.

Every time there is a change in recommendations or advice, medical receptions field calls from concerned people trying to book in to talk to a GP or to cancel bookings. This is on top of supporting patients and juggling the extra workload required to perform COVID-19 triage, screening and telehealth.

GPs and practice nurses are considered central and front line in Australia’s primary care COVID-19 response. However, GP receptionists are one step in front.

Their role has changed considerably during the pandemic, taking on functions and learning new skills no-one planned for. We must not forget them and the stressful work they do.

All in a day’s work

Medical receptionists are an integral part of general practice teams and GP clinics would be challenged to exist without them. Doctors, nurses and other staff rely on medical receptionists to create a friendly, welcoming and well-organised front-of-clinic for patients.

Some people assume medical receptionists “just” answer phone calls, notify doctors when patients have arrived and make follow-up appointments. But this not only understates their true impact and influence on our health system, it does not acknowledge the challenges and pressures of their work.




Read more:
How can younger Australians decide about the AstraZeneca vaccine? A GP explains


Long before the pandemic, medical receptionists were increasingly undertaking clinical duties, performing tasks involving direct patient assessment, monitoring and therapy.

Medical receptionists were typically in this situation because of a lack of financial support for practice nurses. But, given receptionists are not trained health professionals and are continuously handling confidential information about patients, there’s the risk they may be held legally liable for making a mistake.

Then came the pandemic

The role of medical receptionists has profoundly changed due to the pandemic, though they have not being included in pandemic planning.

The Royal Australian College of General Practitioners has said many receptionists have been providing health and safety advice to patients and the wider community.

They are routinely asking patients questions about their travel history and symptoms, and monitoring body temperature to assess the risk of a patient being infected with COVID-19, despite not being trained to make clinical decisions.

They are increasingly performing basic triage over the phone and at the front desk, essentially assessing “how sick” a patient is and how timely their care needs to be.

Particularly during the pandemic, it is usually their decision whether a patient is granted a face-to-face appointment, seen in their car, placed in an isolation room for their consultation, or asked to go to the hospital instead.

Medical receptionists are also relied on for technical support for telehealth and to train clinicians and patients to use it.

Deciding if a patient is suitable for telehealth alone requires a basic understanding of what the doctor might need. We wouldn’t expect any medically untrained person to make these decisions, yet we expect our receptionists to.




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No wonder it’s stressful

Medical receptionists are rightly concerned about contracting COVID-19 as they are so close to unwell patients in the waiting room.

Threats of violence from frightened patients are also now a reality. And when a patient has not been booked in correctly, or worse, when a patient enters a consultation room showing COVID-19 symptoms, they cop dissatisfaction from clinicians and patients alike.

Woman looking stressed or scared wearing a mask
Working as a medical receptionist in a pandemic can take its toll.
from www.shutterstock.com

The emotional demand on medical receptionists is also very high. Supporting clinical teams and their personal feelings and expressions is now part of the job, as well as advocating for, and empathising with patients.

They do all this for an average A$23.96 an hour, much less than administrative or secretary work outside the health-care sector.

Training and support are critical

There is no required qualification to become a medical receptionist. However, courses such as a Certificate III in Business Administration or Certificate IV in Health Administration are recommended. Truthfully, no training exists to equip medical receptionists for the additional pressures of the coronavirus pandemic.

Informal tips are circulating about how practice owners can support staff to avoid burnout, and also how medical receptionists can enhance their clinical and triage work.

Unfortunately, current tips and training do not address the fundamental problem of medical receptionists not being recognised, trained or paid accordingly for their growing clinical, management and administrative work.

Get vaccinated, be kind

GP clinics still play a vital role in getting Australians vaccinated and helping us emerge from the pandemic. That’s on top of their existing role.

Receptionists are at the front line of this pandemic, changing what they do at a moment’s notice to keep the rest of their teams and community safe. Their many hardships are well overdue for our respect and recognition.


Tracey Johnson, CEO of Inala Primary Care, a large GP clinic and charity in Queensland, contributed to this article.The Conversation

Lauren Ball, Associate Professor/ Principal Research Fellow, Griffith University; David Chua, Primary heath care research fellow, Griffith University, and Katelyn Barnes, Postdoctoral Research Fellow, Griffith University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Under-40s can ask their GP for an AstraZeneca shot. What’s changed? What are the risks? Are there benefits?


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Nicholas Wood, University of SydneyPfizer remains the “preferred” vaccine for Australians aged under 40, due to a small but real increased risk of a rare clotting disorder.

But last night Prime Minister Scott Morrison said younger Australians who didn’t want to wait could ask their GP for an AstraZeneca vaccine instead.

So far 29% of Australians have received a first dose of a COVID-19 vaccine, and 7% have had their second.

While Australia has low numbers of COVID-19 cases overall, outbreaks and lockdowns are causing significant disruption in our lives, prompting some younger people to seek out a vaccine.




Read more:
We shouldn’t blame young people for ‘jumping the queue’ to get a COVID vaccine. They could be doing us a favour


In most states, people under 40 may have not yet been vaccinated if they’re not in a priority or high-risk group, as the national rollout is yet to offer Pfizer to under-40s.

But this statement from the prime minister opens up access to an AstraZeneca vaccine for anyone under 40 years.

The prime minister also announced an indemnity scheme to cover GPs who give the AstraZeneca vaccine to someone who has a severe adverse reaction. But the finer details of this new scheme, and what it covers, are not yet available.

Astra wasn’t ‘banned’ for young people, just not ‘preferred’

The Australian Technical Advisory Group on Immunisation (ATAGI), a group of vaccine experts which advises the government, recommended on April 8 that Pfizer be the “preferred” vaccine for adults aged under 50.

This recommendation was based on a risk-benefit assessment at the time. The increased risk of the rare but serious clotting event following AstraZeneca vaccine in those under 50 years outweighed the potential benefit, given how much COVID-19 was circulating at the time.

However ATAGI said AstraZeneca could still be used in adults aged under 50 years where:

the benefits are likely to outweigh the risks for that individual and the person has made an informed decision based on an understanding of the risks and benefits.

ATAGI then updated its advice on June 17 to say Pfizer was the preferred vaccine for those under 60 years.

This increase in age recommendation was because new data identified a higher risk of clotting after AstraZeneca among 50- to 59-year-old Australians than had been reported internationally and initially estimated in Australia.

ATAGI reiterated on June 17 that AstraZeneca could be used in adults under 60 for whom Pfizer wasn’t available, where the benefits outweighed the risks for the person, and they made an informed decision.

What about now?

Last night the Prime Minister said:

if you wish to get the AstraZeneca vaccine, then we would encourage you to go and have that discussion with your GP.

Professor Paul Kelly, Australia’s Chief Health officer later clarified:

there’s a preference for Pfizer up to the age of 60. But that preference is a preference. It’s a discussion for doctors to have with their own patients and work through their own risk and benefit in relation to that.

What should you weigh up?

Resources such as this decision guide can help you weigh up the potential benefits and harms for your circumstances, to make an informed decision about the AstraZeneca vaccine.

So, what are the side effects and more serious adverse effects?

The common side effects of AstraZeneca vaccination include fatigue, headache, body aches and fever and, rarely, anaphylaxis. These are most often after dose one and happen in the first two to three days after vaccination.

We know this because Australia’s active safety surveillance system, AusVaxSafety, has captured vaccine reactions in over one million surveys, including more than 350,000 people who have had a first dose of AstraZeneca.

Health worker putting a bandaid on a person's arm after vaccination.
We have a good idea of the side effects and adverse effects from the AstraZeneca vaccine.
CDC/Unsplash

The clotting condition which causes most concern is called thrombosis with thrombocytopenia syndrome, or TTS. This involves blood clots (thrombosis), often in places we don’t usually see clots, such as the brain and abdomen.

It also causes low levels of blood clotting cells called platelets (thrombocytopenia).

We still don’t know the exact mechanism of TTS, but it appears to be caused by an overactive immune response, which is very different from other clotting disorders.




Read more:
How rare are blood clots after the AstraZeneca vaccine? What should you look out for? And how are they treated?


The estimates of clotting risk associated with first doses of the AstraZeneca vaccine are listed in the chart below. New cases detected are updated weekly on the Therapeutic Goods Administration (TGA) website.


The Conversation/ATAGI

(Keep in mind, the risk estimates in the under-50s are based on a much smaller number of people who received the AstraZeneca vaccine compared to those over 50.)

The severity of illness due to TTS ranges from fatal cases and severe disease, which is more likely to occur in younger people, to relatively milder cases. In Australia, the overall chance of dying from TTS is 3-4%.

It’s not currently possible to predict who will develop TTS. The only risk factor for TTS identified right now is age – it’s much less likely to occur in older adults than younger people.

TTS appears to be far more rare following second doses, with data from the United Kingdom indicating a rate of 1.5 per million second doses.




Read more:
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In a nutshell

So, if you are under 40 years old and want to get a COVID-19 vaccine the options are:

  1. wait until Pfizer becomes available for your specific situation (you can use the vaccine eligibility checker to see when you’re eligible)
  2. think about getting an AstraZeneca vaccine.

The best advice is to discuss with your GP your own unique story, and the risks and benefits as they relate to you.The Conversation

Nicholas Wood, Associate Professor, Discipline of Childhood and Adolescent Health, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

What can you use a telehealth consult for and when should you physically visit your GP?



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Brett Montgomery, University of Western Australia

As of this week, everyone with a Medicare card is eligible for Medicare-funded telehealth. That means you can have a consultation with your GP, psychologist and other health providers via video or phone, rather than going in.

This should help with social distancing – a core weapon in our community’s fight to contain this epidemic.

Some but not all health care can safely be shifted online. But it can be difficult to know when it’s OK to skip the in-person visit. Here are some pointers to get you going.




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What you can do via telehealth

There’s a saying in medicine that “history is 80% of diagnosis”. By “history”, we mean the things our patients tell us; fortunately, video and telephone connections convey your voices and stories well.

So for issues where doctors and patients mainly need to speak, and where the risk of serious illness is low, telehealth consults are a good option. Evidence backs this up, finding fairly satisfied doctors and patients – and sometimes even cost or time savings.



The Conversation, CC BY-ND

I’m most comfortable using telehealth with patients I know well, and when we are managing long-standing health issues. For example:

  • routine chronic disease management, especially where the condition is fairly stable – for example conditions such as diabetes, high cholesterol or high blood pressure

  • writing repeat prescriptions for medicines used in long-term illnesses – like the examples above, or tablets for contraception, stomach acid or chronic pain

  • exploring mental health issues

  • discussing diet and physical activity

  • writing referral letters.

Some conditions can also be monitored remotely. In particular, many patients with high blood pressure can safely measure this using a machine at home. This is recommended in blood pressure guidelines, as it’s actually more reliable than clinic readings.

But home blood pressure monitoring won’t be a solution for everyone. It needs careful technique, and also enough money to buy a machine.




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Blood pressure targets – what does the new guideline say and how low should you go?


Some simple short-term illnesses might also be managed via telehealth, as long as the risk of anything serious going on seems low. Examples could include straightforward urinary tract or upper respiratory tract infections.

But there is a worrisome overlap in symptoms between common viral infections and the early symptoms of COVID-19. Guidelines are being written to help GPs assess, over telehealth, who needs to simply isolate, who needs testing, and who needs to go to hospital.

What you need to see a doctor for

Sometimes a physical examination is important. There are all sorts of presentations in which I might need to listen to your heart or lungs, or feel your abdomen, or take your temperature if you don’t have a thermometer at home. This is especially the case when symptoms are new.

Photographs are tricky. I can’t expect patients to be able to describe or photograph a changing skin lesion well enough for me to make decisions. (Often these are benign, but I’d hate to miss a skin cancer.)




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There are procedures that can’t be done via telehealth. Excising skin lesions, taking swabs and smears, inserting long-acting contraceptive devices, giving injections – these simply don’t happen “virtually”.

Particularly important right now are flu vaccinations: while these offer no protection against coronavirus, they may stop the dangerous “double whammy” of getting influenza and coronavirus together.

You’ll need to go in for your flu shot.
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Read more:
The ‘dreaded duo’: Australia will likely hit a peak in coronavirus cases around flu season


What you might need to put off

Some routine checkups and screening tests, in low-risk people without symptoms, might simply best be put off until this pandemic settles. But it’s hard to generalise. If in doubt, ask a doctor who knows you well.

Bookings, prescriptions and blood tests

When booking an appointment, don’t simply book a face-to-face appointment out of habit. Hopefully reception staff will offer the telehealth option, but this is all new, and it can’t hurt for you to raise the idea too.

When GPs aren’t sure whether telehealth is appropriate, we can begin with a telehealth conversation, then swap to a traditional consultation if needed.

Prescriptions and blood test or imaging referrals are currently awkward via telehealth. I can mail non-urgent prescriptions and requests to patients, pharmacies or other providers.

For urgent prescriptions, we’re using a messy combination of phone calls, faxes or emails to get instructions to pharmacists quickly, and then mailing the originals.

Fingers crossed, there will soon be reforms allowing purely digital prescribing.

Just an interim measure for the pandemic?

Medicare has previously been very strict about only funding GP consultations when they happen face-to-face. The shift to funding telehealth has been forced by the coronavirus pandemic; so far the government is promising telehealth funding to late September.

Like patients, not all practices are ready for video consultations. Webcams, like facemasks and hand sanitiser, are hard to find. And we’re still learning which video services tick all the boxes for function and privacy.

Doctors, like patients, are still working out how to consult via telehealth.
Shutterstock

At a better time in history, we’d confine telehealth consultations to the obviously safe consultations, and do all the other ones face-to-face.
But we currently need to balance the risks of forgoing some physical examination and procedures against the risks of potential exposure to coronavirus.

Research evidence on telehealth isn’t much help, because it wasn’t done in the coronavirus era. Instead, we need to be as safe and wise as we can, and learn as we go.

I hope we’ll be able to lay the foundation for telehealth not just as an emergency measure, but as an enduring feature of general practice – complementing rather than replacing face-to-face consultations.




Read more:
Is your mental health deteriorating during the coronavirus pandemic? Here’s what to look out for


The Conversation


Brett Montgomery, Senior Lecturer in General Practice, University of Western Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Want to Skype your GP to avoid exposure to the coronavirus? Here’s what you need to know about the new telehealth option



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Centaine Snoswell, The University of Queensland and Anthony Smith, The University of Queensland

From tomorrow, some Australians will be able to consult their doctor or other health professional with a bulk-billed videocall rather than in person, in a move designed to limit the spread of the coronavirus among vulnerable people.

This measure will also help reduce the risk of transmission to health-care providers.

Yesterday’s announcement of these new telehealth measures comes as the World Health Organisation has upgraded the status of the coronavirus COVID-19 epidemic to a pandemic.




Read more:
‘The doctor will Skype you now’: telehealth may limit coronavirus spread, but there’s more we can do to protect health workers


Who’s eligible?

People in home isolation or quarantine as a result of the coronavirus, and those at high risk of complications if exposed to it, will be eligible for bulk-billed telehealth consultations with doctors, nurses and mental health professionals.

Eligible vulnerable groups include:

  • people aged over 70
  • Indigenous people aged over 50
  • people with chronic health conditions or whose immune system is compromised
  • parents with new babies
  • pregnant women.

Existing Medicare-funded telehealth services in Australia normally refer to a consultation by videoconference, and don’t specify a particular software or platform.

However, yesterday’s announcement says these new telehealth services could be conducted by phone, or video, giving FaceTime or Skype as examples.

People in isolation or quarantine for COVID-19 will need to meet certain criteria and can videocall any eligible health provider.

However, those in vulnerable groups with a non-coronavirus matter can only videocall a health-care provider they have seen in person during the previous 12 months.

This may be a problem for people who do not have a regular health-care provider, or whose regular health-care provider is either ill-equipped or unwilling to provide consults via telehealth.

What are people eligible for and for how long?

Eligible people can not only access medical treatment by telehealth, they can also access mental health support.

The government acknowledges that home isolation, quarantine periods and/or the spread of COVID-19 can be stressful and could lead to mental health problems without support.

Other countries have also recognised mental health concerns. The World Health Organisation released advice this week on how to support the mental health of both patients and providers.

These newly announced telehealth measures are temporary, costing A$100 million over an initial period of six months. We don’t know whether the funding or time frame will be sufficient.

Telehealth in emergencies isn’t new

Telehealth has been used in Australia and overseas for decades. And in research to be published soon in the Journal of Telemedicine and Telecare we discuss how there’s good evidence it’s effective, especially in disaster situations.

For instance, telehealth was used after Hurricane Sandy in the USA in 2012, after an earthquake in Japan in 2011, and during the Boston blizzard in 2014.

In our forthcoming research paper we also discuss issues associated with implementing telehealth.

Telehealth can be very useful for a broad range of clinical services, but it can’t replace all in-person consultations. Some assessments, and all procedures, will still need to conducted in person.

Some Australians will be able to consult their doctor by taking a Skype call on their smartphone. But not everyone has reliable internet access.
Shutterstock

Patients also need access to a device capable of videoconferencing (for example, a phone, computer, or tablet), as well as a reliable internet connection.

About 85% of the population has internet access at home. So there are people who may not be able to use telehealth services from home.




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Virtual reality may be the next frontier in remote mental health care


Effective uptake of telehealth also relies on clinicians changing the way they interact and communicate with patients, a process that can be challenging for some.

So we need to provide adequate training and education to emerging and current health-care workers. We also need to ensure the general public is aware of telehealth and understand how to access it.

What might happen in the future?

The uptake of telehealth in Australia has been somewhat slow and fragmented so far.

However, the use of telehealth during the coronavirus pandemic might change this. People may become more aware of telehealth and accept it.

If it was used routinely in every health service, it would improve access to health care particularly in rural and remote areas, reducing the need for extensive travel.

Routine use would also mean our response to future pandemics and disasters would be much more timely and effective.


Researchers from our team at the University of Queensland’s Centre for Online Health, Centre for Health Services Research and the NHMRC Partnership Centre for Health System Sustainability contributed to research mentioned in this article.The Conversation

Centaine Snoswell, Research Fellow Health Economics, The University of Queensland and Anthony Smith, Professor, Director of the Centre for Online Health, The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

My Fight with CFS … Part 1


I have Chronic Fatigue Syndrome (CFS), or as I prefer to call it, Chronic Fatigue Immune Dysfunction Syndrome (CFIDS). It is an extremely misunderstood and debilitating illness. I have read that the average time for a person to be ill with CFS is 18 months. I have had it for 18 years more or less. It has cost me a lot to be suffering from this illness and it impacts on my life on a daily basis. Some days are not too bad, while others are extremely terrible.

My journey with CFS began in the aftermath of the Newcastle earthquake of the 28th December 1989. In early 1990, while working at Hawkins Masonic Village repairing roofs damaged by the earthquake (it was raining and many roofs were leaking), I began to feel persistently unwell. I decided to see my doctor who put it down as some sort of stomach bug, most likely Gastroenteritis. After two weeks of medication it was becoming clear that I did not have Gastroenteritis and something more sinister was the cause of my intensifying illness.

Within weeks I had begun to develop all of the debilitating symptoms of CFS and what was worse for me they were all intensifying their effects upon me. What was wrong with me was now something of a mystery, but it was clear I was very ill and getting worse.

When I was younger I had Hyperthyroidism and so the doctor assumed that this was what was wrong with me again, despite the fact that blood tests indicated I no longer had an issue with that disorder. I was placed on medication for Hyperthyroidism and monitored. The medication had no effect on my illness and my patience with ‘witch doctoring’ was running out. I pleaded with my doctor to send me to someone else – a specialist. But who would be useful to see?

A friend had recently been diagnosed with CFS by an Immunologist and eventually I prevailed with my doctor to send me to him. Eventually I was able to set up an appointment and so my time with Doctor Sutherland of the Royal Newcastle Hospital Immunology Department had begun.

By this time I was suffering a myriad array of symptoms, with varying degrees of intensity depending on what week I was asked. Among the most debilitating of these symptoms was a persistent headache that no amount of painkilling or other medication had any impact upon. The headache was like a migraine that wouldn’t go away. It would last for an 18 month stretch this first time, bringing with it an intolerance of bright light, noise, etc. These things caused me immense head pain.

I was also suffering numerous nose bleeds (which I often get when I am very ill), fevers and chills, brain fog (a situation where you seem to know what is going on yet you have an inability to act in a logical manner – some times the sense of knowing what is happening disappears altogether), painful eyes, chronic fatigue in the muscles and extreme soreness, tiredness to the point of sleeping at a drop of a hat (I was sleeping for over 18 hours a day with no relief to my tiredness, headaches, etc), loss of strength in my limbs, constant nausea, inability to think or concentrate, etc.

By this time I was already having time away from work, with being away for weeks at a time being the norm – thankfully they were quite understanding of the fact that I was very ill.

At my lowest point during these first two years I was reduced to being bed-ridden, using a cane for stability when walking and at times was unable to walk. I was sleeping above 18 hours a day with no benefit from it.

During this time of extreme illness I was subjected to innumerable blood tests and other tests, which all revealed little at all as to the cause of my illness. A process of careful elimination under the care of Dr. Sutherland brought the diagnosis of CFS, as well as a psychological evaluation.

There was no cure to be found, with the only helpful advice having come from Dr. Sutherland. He told me to try and rest, then to slowly build myself up again. Walk one block for a week, then two blocks the following week, etc. If I overdid it I would be back in a heap again in no time. I needed to be able to read my own situation to know when I should try to rebuild my life. This advice has helped me through the last 18 years.

I struggled with the illness for 18 months or so and I also struggled with the enigma associated with the illness. That I was sick was not believed by all and this has been a constant stereotype I have been confronted with throughout my illness. I often found myself questioning whether I was sick or whether it was some mental thing. It was a relief when a doctor finally gave me a name for the illness and confirmed I was indeed very ill.

There were times (as there has been since) when I thought that dying would be a better alternative than to be as sick as I was, with no life and the prospect of endless years of severe illness. Suicide was something that popped into my head from time to time, but thankfully it didn’t stay there for long.

At times I found myself not knowing what I was doing, where I had been, etc. At one point I waited behind a parked car, waiting for it to turn the corner only to realise ½ an hour or so later that the car was parked. I found myself having gone shopping with a load of groceries I didn’t need and never had used before. It was like having a form of early onset Dementia.

After about 18 months I began to get better – or so I thought. I was well enough to knock back participation in a trial medication experiment for CFS sufferers which would involve a lengthy stay in hospital and a 50% chance I would receive the placebo.  I declined the invitation being concerned I would loose my job as a result of being in hospital for so long.

My health began to improve and I thought I was finally over the illness. During this time I lost contact with Dr. Sutherland who left the hospital because of a dispute with NSW health at the time. Many doctors left the public system at the time.

NEXT: The illness returns