GP who lost her job to long COVID urges doctors not to underestimate the condition

A GP with long COVID has urged other doctors to listen to patients who have the illness and not to underestimate the suffering and fear many have been through, particularly those who became unwell early in the pandemic.

Dr Amy Small
Dr Amy Small

Dr Amy Small, a GP in Lothian, Scotland, said: 'It's really important to remember when you're seeing patients, particularly from the first wave, we went through this alone. We stayed at home to protect the NHS, we did as we were told, we sat and watched our SATs drop into the 80s. We really managed this at home on our own.'

Speaking at the RCGP annual conference in Liverpool she said that while there was recognition that some patients who had been hospitalised with COVID had PTSD, there were also people who had remained at home who were also suffering from the condition.

'I think we need to remember how much was suffered alone on this and how much impact that has had,' Dr Small said. 'How no one knew what we were going through, how there was no one there to support us, how many of us were treated over the phone with antidepressants and not investigated for things like postural orthostatic tachycardia syndrome (POTS), even though our symptoms mimicked this.

'So please just listen to your patients, hear them out, hear their story. And don't jump to conclusions as you may have in the past and keep an open mind and be curious.'

Long COVID

Dr Small told the conference that both herself and her husband, who also has long COVID, first became ill in March 2020. Before her illness she was fit and active and a six-session a week partner in a practice in Edinburgh.

Four weeks after the initial infection she was still experiencing fevers and, after having a number of investigations, doctors were unable to explain what was happening to her.

'I went through a lonely place at the beginning,' Dr Small said. She explained that during the first three months she had severe brain fog and her speech would slur if she overdid things.

'I was incredibly breathless and I couldn't walk up stairs. My husband was also really struggling,' Dr Small said. 'By June I thought "I've just had enough". I still had a fever every day but my colleagues were happy it was not infectious, so I thought I'd just push through and go back to work.'

However after a half day doing paperwork, followed by another half day in a clinical session she told the conference she had 'the biggest relapse'.

Impact of cognitive fatigue

'I went home that afternoon and didn't feel well, so I went to bed. I didn't really get out of bed for about 10 days. For 24 hours I could hardly speak. The muscles in my face were too sore, too tired...to eat, I could hardly drink. I could hardly lift my hand, ' Dr Small said.

'It was just extraordinary and I never had, until that point, realised how cognitive fatigue can cause such debilitating physical symptoms. And then I panicked.'

Dr Small said she was initially concerned she was developing ME and started to wonder if she was ever going to get better.

In the following months Dr Small then lost her job as a GP partner because her practice had a clause in its partnership agreement that allowed partners to be removed if they were unable to fulfil their duties for a six-month period.

However, Dr Small then discovered that taking Beta blockers had a huge impact on her health. 'I was less breathless, I could walk a bit faster, I could go up the stairs without stopping. And actually that's what made me think: "Have I got POTS?".'

Two weeks after starting taking the drugs she could walk normally and keep up with her four-year-old son. She started a phased return to work as a locum and by January she was working full time as a portfolio GP, including advising the Scottish government on support for patients with long COVID.

The importance of pacing

She explained that she came off the medication in the summer, although has had another relapse since having her booster vaccine and has had to restart medication.

Along with medication Dr Small told the conference that 'pacing' had been an important part of her recovery.

'I didn't really understand what pacing means. And what pacing meant when I was really ill was when I was cooking, I would go to the kitchen and rather than stand I would sit at the table and peel the carrots. And then I would go back to the living room, and I would rest. And maybe an hour or so later I would go back and I would cut the carrots, and then I would go and rest. And then maybe an hour later I would go back and cook the bloody carrots.'

She said she had to plan her days and if she wanted to take her son to nursery that would have to be her priority for the day and she wouldn't be able to do much else.

She said other things that her and other long COVID sufferers had tried that had helped was cutting out alcohol, sugar and caffeine. She said that acupuncture had helped her husband and other people found mindfulness useful as well as yoga, pilates or Qigong.

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