“May you live in interesting times…”

We certainly do…

In response to the Coronavirus crisis, I am implementing some changes with regards to appointments. We need to take precautions to contain the spread of Coronavirus and I will be trying to do this. However, we must maintain our civility, keep our sense of humour and take appropriate and proportional steps.

I have sent an SMS to all my pregnant patients today:

“Due to Coronavirus, I am forced to implement the following: do not bring children or additional people (other than partner) to appt; do not attend if you have returned from overseas (anywhere) in last 2 wks; if you have fever, cough or are unwell you MUST CALL AHEAD for advice. I must protect pregnant women from exposure. Additionally, exposure of my staff may result in forced closure of the practice. If I am exposed or become unwell I will not be able to see patients or attend deliveries for 2+ weeks. Thank you for understanding. Further info will be on website and/or FB page.”

The community measures being taken to contain the spread of this virus seem extreme, but I am not an expert and I defer to more intelligent and experienced doctors and authorities who aim to protect our community. As with other viruses, the people most at risk are the immunocompromised – pregnant women, the very young, the elderly and those with chronic illness. As such, I need to take some action to protect my pregnant patients, in particular, and also my staff.

We have previously dealt with SARS, ‘swine flu’ and the common garden-variety Influenza. These have all represented a risk to pregnant women, with the benefit that at least there is a vaccination for Influenza that provides some measure of protection. Coronavirus seems more contagious, and it with this in mind that I am taking more precautions.

I recommend that only women (and their partners if necessary) attend for appointments. Children have no concept of avoiding coughing and sneezing over everything; slobbering, touching and licking everything in sight. People who are unwell clearly need to avoid exposing themselves to others (including my staff and myself). Although some countries represent a greater risk, there is no ‘safe’ country or ‘safe’ airport, so at this stage I recommend not coming for an appointment if you have come from overseas in the last 2 weeks. When in doubt, call ahead and we can make arrangements. I do not intend to avoid seeing sick patients – they need medical attention, of course – but calling ahead and giving us warning will allow me to take steps to appropriately protect my staff, other patients, and myself.

I recognise the difficulties in arranging childcare for an appointment. I will try to accommodate patients who need to reschedule due to lack of childcare. Likewise, I will accommodate patients who have come from overseas.

Just on Friday, a GP at The Toorak Clinic, a very good GP practice from which I get referrals, tested positive to Coronavirus. Despite having returned from the USA, not a country (yet ) deemed at risk, he has contracted the virus. This has forced the clinic to be closed. The ridiculous and offensive comments made by the Victorian Health Minister (who was ‘flabbergasted’ that a GP would turn up to work who was mildly unwell/ recovered and not returning from a high-risk country) indicates there will be no tolerance by the Government for healthcare workers, who have been exposed or unwell, seeing patients. Her comments indicate a complete ignorance of the way the healthcare system works (and she is the health minister…). Doctors frequently go to work and see patients when they are unwell themselves. So do other healthcare workers. If doctors stopped seeing patients when they had a sniffle, the whole healthcare system would grind to a halt. It is not that they wish to infect patients, but in my experience most doctors continue to work with disregard to their own wellbeing because, firstly, patients get annoyed if they are not seen as arranged (or are at risk because they cannot get medical care) and, secondly, they know the workload will fall to their colleagues (who are probably already overwhelmed with work).

As doctors, we consider the nature or seriousness of an illness (including how contagious it is), the risk to the patient, the special vulnerability of the patient and following the steps necessary to minimise the risk of transmitting a disease to our patients (or other staff). I have had THREE sick days in 25+ years of practice. This is likely due to being in generally good health*, practising extremely careful hand hygiene, being vaccinated, taking care to avoid contracting illnesses from my patients and sometimes pushing through despite my own discomfort. When I do push through and attend work I am meticulous to reduce risk to others.

The measures I am taking are simple. Less people in the office will reduce the risk of exposure. You will be asked to observe simple measures such as handwashing for 20-30 seconds before entering the office. Your child/ children or other people with you will be asked to wait outside. You may be asked to follow other directions. These precautions are all taken with a view to protecting everybody. This crisis is about more than the needs or desires of an individual patient. Please be respectful to my staff. They are at risk too. If we recommend rescheduling an appointment or decline to see you at a particular time, this is not a personal rebuke. It is simply old-fashioned infection control.

We must protect each other, and that includes my staff and myself. If my staff are infected, the office may be forced to close. If I am exposed (including if my staff get the virus) or I am infected, I will be forced to not see patients or attend deliveries for 2+ weeks. If my other obstetrician colleagues are similarly affected, any patient may be forced to see GPs or attend public hospitals (eek! ). In fact, for pregnant women, private obstetric care has the advantage of being booked in a hospital with an ICU* and seeing an individual doctor. It is easier to control the risk of exposure in a private setting than in a public hospital clinic.

Be reassured, I will never abandon my medical responsibilities. I have already contemplated, and am preparing for, the worst case scenario if I cannot physically see patients. This may include telephone/ video consultations and other measures. My primary responsibility will be to limit my exposure to avoid contracting Coronavirus so I can still attend and perform births. Of course, if I die from Coronavirus you will need to find another doctor (sorry….).***

I hope that everyone will be understanding of these measures. Hopefully, they may not be required for too long.


*Some would say it is only my sense of humour that is sick
**St Vincents Private has an intensive care unit. I hope you never see it…
***A joke but kind of true.