Why things will never be the same again

The GPs of Ireland have taken on without demur a load of extra work and danger. With many squirts of the sanitiser we have logged on and played a full and unreserved part in the national plan to contain the coronavirus.

We organised our practices to make it safe for patients and staff. They began to resemble call centres more than the rough-and-tumble of everyday clinical care. We texted, Whatsapp-ed each other with the latest scraps of information that were ahead of the curve. ‘Do we have a test?’, ‘where is it?’, ‘how long do you have to wait?’, etc.

Dramatic new work practices emerged that changed a face-to-face GP service overnight to remote consultations, with Covid-19 tests ordered online via Healthlink. We now have funding for telemedicine that will hopefully outlast the pandemic. 

GPs worked with public health, Department of Health and the HSE to bring effective care to our patients. The system learned early on that if we are going to make a fist of this thing we needed our GPs on board fully. Dr Tony Holohan, the chief medical officer, has been clear in his gratitude and respect for GPs’ work, and GPs have been full of respect for the public health advice.

GPs have been active on social media. The ESRI social behaviour expert Pete Lunn says that highlighting and following advice and sharing examples of others doing good helps. Polite social disapproval for those who don’t follow advice is important too. GPs have not been backward in calling out the Temple Bar drinkers or the racegoers in Cheltenham who should have known better.

The Medical Council was into the fray at an early stage. It recognised that fear and authoritarianism has had its day; that to deliver medical care in a crisis we need doctors to be well, safe and rested. No heroics, just common sense and “please remember that during this challenging time the Medical Council stands by your side”: Dr Rita Doyle telling us she is proud of us. Things will never be the same again.

Patients have been invited into our world of uncertainty and anxiety. Where doctors had been complaining of an air of increasing menace – vengeance even – the atmosphere changed. We told patients don’t come near us if you’re symptomatic. We’ll provide a good enough service but on our terms of safety and we’ll do the best we can in the circumstances. It has been accepted without complaint. Patients recognise that this fragile line of medical humans is all that exists between them and chaos.

GPs have worked with others from the beginning. No such thing as a multipage memo from the HSE that goes largely unread. There was Dr Nuala O’Connor on YouTube in her plastic apron quizzing microbiologist Dr Cormican on what we needed to do to keep the surgery and our patients safe. The ICGP uses the best of our own people with the latest methods of communication to get us up to speed promptly. 

And then there is Dr Mary Favier dropping a word in the ear of the nation on Morning Ireland. You can feel the urgency as she answers the good Bryan Dobson as clearly as present information allows, while she squints at her computer screen as it fills up with people who want a call back. 

The media have taken a break from the super specialists persuasively telling the world about how badly Ireland is doing in their particular specialty and how we need more of them if we are to do as well as other places, and how patients will die if we don’t spend, spend, spend. There’s really no time for that indulgent behaviour now. It’s ‘senior hurling’, as we say in Trinity.

Again, Pete Lunn advises that when communicating risks, media and official bodies should avoid highlighting specific or extreme cases and instead use ranges, noting that the middle of the range is most likely. This is where the generalist does best. In the Irish Times Dr Blainaid Hayes eloquently told “doctors who were not specialists in the relevant field of medicine or science” to stop undermining the public health message as they are distorting it and creating fear.

Things will never be the same again. Dr Doyle, Dr O’Connor and Dr Favier have presented a modern, progressive face of medicine. A face of authority, competence and kindness. GPs have assumed equality and have been treated equally and respectfully. Gone is the victimhood that we have used to deal with the way the government slashed and burned general practice in the past. 

The same people who stoked the fires of austerity under us are now grateful, respectful and admiring of general practice, ably led by the ICGP and the IMO.

Of course we won’t forget, but once you assume equality the world looks different. Victims get pushed around, patronised and taken for granted. That’s not where general practice in Ireland will be at when this pandemic is brought under control. Patients, the public, politicians, hospitals and paymasters will sense it. 

Yes indeed, nothing will be the same again.