Day in the Life: A GP Having End-of-Life Conversations Over Video Call

Dr. Bushera Choudry is COVID-19 lead at a GP surgery in Salford, Greater Manchester. We asked her to keep a diary of her life during the coronavirus lockdown.

I usually wake up at 6AM and I’m lucky to have enough time to play with my son before going into the surgery. I’ve just returned to work after eight months off for maternity leave, so when I came back, it was straight into dealing with coronavirus. It’s been really busy.

At my surgery, we have a rota, which means that only one doctor comes in each day. Today, that’s me.

I start at 8:30AM, and go straight to my room where I’ll stay all day – all communication is now done electronically or over the phone. The receptionists are in their own rooms too, so I don’t see them. I think that’s something our patients miss: being able to come into reception and see friendly faces who they have known for years when they pick up their prescriptions. But now that’s all electronic, to minimise any risk of infection.

My mornings are spent doing telephone and video consults, which can be tricky. We’re having to have conversations about end-of-life care and DNR [do-not-resuscitate] procedures, which we would normally do when seeing the patients and their families. You can’t communicate in the same way as when you’re seeing someone face-to-face. Today, I spoke to a patient who has cancer and his wife, just to console her. They usually come into the surgery, so I hadn’t had a chance to catch up with her. I’ve known this couple for the entirety of the 10 years I’ve been working here, so it was nice to be able to give her some support.

There’s been an increase in people looking for mental health support, too. I’ve had patients who are really anxious and others who have been on antidepressants in the past, feeling like they need to restart their anxiety medication again because they’re not coping without any social interaction. Loneliness is a big issue.

A lot of patients have said that they don’t want to go to hospital, for fear that they would go in and never come home again. They don’t want to be in an environment where they’re alone. My A and E colleagues are saying similar things. People are leaving important symptoms like chest pains really late because they’re frightened of going to hospital and have then had heart attacks.

As the COVID-19 lead at my surgery, in the afternoons, I have daily meetings with leads from other practices in my locality to discuss any queries related to coronavirus, as well as staffing issues, helping each other to source PPE and computer and IT issues. We’re also trying to understand why coronavirus is disproportionately affecting the BAME population. Another troubling thing I’ve seen is the amount of patients in their eighties who don’t have anybody to help get their medication. It’s really sad but there are lots of community initiatives that we’ve been able to point those patients to, to get the help they need.

Towards the end of the day, I will see if any home visits are needed. I’ll call the patients, triage them and then organise to visit them – if it's appropriate to go over. Luckily, we were able to self-source PPE for the surgery in order to be as safe as possible. People have also been running community projects that have created 3D-printed visors. A local school donated some goggles and we purchased masks and scrubs over the internet. So, before going over, I will change into my scrubs and then put on the full PPE gear. I’ll ask the patient if they can open windows or a door to make it as well ventilated as possible and do all the talking before I go in, so I’m only there to get the examination done. Then it’s back in the car to call them and let them know what we think the plan should be.

At the end of the day, I put my scrubs into a pillowcase, which I then put into the washing machine as soon as I get home. Luckily, the roads are quieter now, so my commute is much shorter and I get home with enough time to shower before saying goodnight to my son.