With the arrival of the COVID-19 pandemic earlier this year, a large number of the population found themselves working from home – and many continue to do so. Some saw this as a silver lining, as they avoided the tedious commute or distracting colleagues. Others found the change more difficult, including myself.
As a GPST1, I had started my six-month placement in general practice a handful of weeks before lockdown. Just as I began to learn the names of the reception team and the quickest route from my consulting room to the coffee room (our practice building is large, and I have a terrible sense of direction), everything changed. I found myself at home armed with only a work laptop and mobile phone, with no idea as to how long this would last.
Of course, the change wasn’t quite that straightforward at the time. There was a lot of confusion – even chaos. At the beginning of March, as whispers of COVID-19 started to swirl and became increasingly louder, the question was simply – should I be seeing patients face-to-face?
Should I be shielding?
I was in my second trimester of pregnancy and, in an absence of guidance at the time, my clinical supervisor and I thought it sensible to take precautions. Initially I just avoided seeing patients presenting with fevers or respiratory symptoms, but as the situation escalated I switched to telephone consultations only.
I would then spend my lunch hour scouring Google for more information on the risk of COVID-19 in pregnancy, for updates in shielding information from the government, and for new guidance from the Royal College of Obstetricians and Gynaecologists (RCOG).
I spoke to the occupational health team from my trust, to my community midwife, and to fellow pregnant doctors on social media, all the time asking, ‘What should I do?’ As a group, we lacked the data and we wanted answers, but the usual evidence-based medicine approach of reviewing the literature on the subject and browsing the latest Cochrane review was not an option.
Eventually more clear-cut occupational health advice for pregnant healthcare workers was published by RCOG, resulting in my and many other pregnant women’'s transfer to remote working. But it was not a smooth transition.
Confusion for patients
That was my own experience, but there was also confusion around what this meant for people with many other conditions as the pandemic progressed and guidance changed. I faced numerous questions from patients as I worked through the daily list of triage queries - what counts as ‘severe’ asthma? Which treatment regime puts you in the stringent social distancing group, and what deems you high risk and needing to shield? What if you’ve had a splenectomy? I’ve had a text from the government saying I should be shielding and to contact my GP for more information?
Healthcare professionals themselves were not immune to this uncertainty, and those who happened to also be patients in the situation were required to make decisions on not just a professional level, but a personal one too.
Following the confirmation that remote working was necessary came the remote working itself. For those of us in general practice, the set up was not at all dissimilar to that of our colleagues in the surgery; telephone consulting could continue, as could processing pathology results, letters and prescription requests, with just a lack of home visits and face-to-face appointments.
I realised many times that I was fortunate to find myself in this position, able to continue with a semblance of normality, while friends of mine in specialties such as emergency medicine and anaesthetics struggled to find projects they could complete from home.
To be able to continue to work and contribute to the effort of the NHS during the pandemic is something which I clung on to, and I think I would have struggled enormously with the prospect of ‘special leave’, granted to those unable to continue their usual working duties.
Challenges of remote working
But despite knowing all of this, there were still so many challenges to remote working. It is incredibly lonely. Having the option to pop your head into a colleague’s room for some advice, a second opinion or just a vent is vitally important for our resilience and resolve and, although I could send an instant message to team members on SystmOne or schedule in a Zoom meeting with my supervisor, it just wasn’t the same.
I also found myself guiltily observing the actions of my peers on the ‘frontline’, whether that be fellow GP trainees, mates working in the hospital, or the rest of the team at my practice. As I saw pictures of them gowned up in layers of PPE, or of the COVID-19 on-call SHO rota (spoiler – it looked relentless) I couldn’t help but feel uncomfortable that I was sat at home while they bravely tackled things head-on.
Finally, from the aspect of an ST1, working remotely stole away so many opportunities for my learning and progression. I have not examined a patient since March 2020, and as I am now on maternity leave, I will not be back to clinical practice until next summer. With this comes the startling realisation that on my return, over a year will have passed since I last used my stethoscope.
I’m sure most of us would have concerns about deskilling over that time period, but for someone at the beginning of their career who was only just really starting to develop and hone those skills, it is even more of a worry.
I talked before about training in the time of COVID-19, and the numerous effects this pandemic has had on the experience of GP trainees. For all our sakes, I hope that working remotely is a consequence we don’t have to endure again in future.
- Dr Zoe Brown is a GP trainee in Gloucestershire
