‘Pandemic’: latest television sensation
In his shortlisted essay for the 2021 John Henahan Prize, Dr Conor Lyons says he hopes that the pandemic will serve as a stimulus for effective dialogue between patients and healthcare staff
As I left my house on the way to work one morning a few weeks ago I noticed my next door neighbour Mr Morris shuffling up the street on his zimmer frame trying to catch my eye.
“Morning Doctor Lyons, I was wondering if you had a minute, I’d like a word.”
“Morning, Mr Morris what’s up?” I said, feeling a little apprehensive. The previous week he had chastised me for not bringing my dustbin in promptly after collection.
“What’s your opinion on the AstraZeneca vaccine?” Slightly bemused I reverted to my standard, “The vaccines have been proven to be safe, the risk of serious complications is very small.”
Somewhat annoyed Mr Morris interrupted. “Yes, yes of course, I was wondering if you felt it was effective in over sixty-fives? I read that the EU is considering limiting it to younger people. Would it be better to wait for the Pfizer vaccine? Would it create more antibodies?”
“Uh well, you see,” I parried, stalling for time. “The Pfizer vaccine is difficult to transport,” he continued eagerly, “what if it’s defrosted too early, will it still work?”
Flashbacks of being put on the spot in medical school ward rounds assailed me. I immediately struggled to form a coherent thought. Mr Morris looked at me expectantly as the seconds ticked by.
“Ehm, I’m actually not really sure Mr Morris” I mumbled, cheeks reddening and hurried to the car.
Surprised at his knowledge and very aware of the limitations of mine I was relieved as I closed the car door and sped off to work, committed to reading up on vaccines later.
Later that same day in casualty I encountered a lady who presented with a very uncomfortable, red eye. I examined the eye and diagnosed her with episcleritis. I mentioned that since it’s severe I’d treat it with a steroid drop and review in a couple of weeks for a pressure check. We also discuss the self limiting nature of the condition. As I started to prescribe the steroid she stopped me, “If it’s going to get better either way, I’d prefer to tough it out.”
“If that’s what you want” I started to reply when she interjected, “I heard steroids cause you to gain muscle anyway.”
Both incidents demonstrate patients taking a proactive role in their health and an eagerness to take the lead in the decision making. Most patients are no longer passive consumers, readily taking their doctor’s word as law. Of course this change has been occurring organically over many years. Since the pandemic I feel the number of patients with this approach is increasing as exponentially as the virus itself.
As people have sheltered, cocooned and shielded in their homes this past year they have been bombarded with twenty-four seven rolling news coverage of every aspect of the outbreak. ‘The Pandemic’ seems to be the most fervently watched soap opera of all time. The butcher who had previously paid attention to the cricket trials now only cares about vaccine trials. The hairdresser who formerly dedicated her time to creating the perfect curls, now debates the best way to flatten the curve. This new fascination with all things medical has spilled over into ophthalmology. More and more of my patients are presenting to the ophthalmology clinic better informed and motivated to understand every aspect of their healthcare. This brings both
opportunities and challenges.
COVID-19 has forced people to think about their health and healthcare needs more than ever before. Patients who previously complained about their early cataracts are now happy to defer their surgery till it’s absolutely necessary. Apart from the risks of catching the virus I’ve noticed that patients are more tentative, keen to know as much as possible about all risks and complications. Recently they have seen that medicine and doctors are fallible. Patients are less and less likely to blindly follow doctors’ advice without making sure they have all the information.
Moving on from the pandemic, the doctor’s role is shifting to guiding patients in the right direction. Patients are more knowledgeable than before but many will harbour half truths and misconceptions. Like my patient with episcleritis and her fear of developing bulging biceps from Betnesol eye drops, many patients willturn up to the clinic with medical myths we need to dispel. Conversely, with so much information available online, there is a distinct possibility that other patients may end up knowing more about their condition than us. I have experience of a patient mentioning a new treatment or trial that Google alerted them to that I was ignorant about. As I realised with my neighbour and his vaccine admitting your own ignorance can be a humbling (but important) experience for doctors.
Reflecting on the effect of COVID-19 in clinical practice is overwhelming. It has altered the most basic aspects of our work, such as how we dress at work; to the most complex, like which sight-saving surgery should be prioritised. In many departments it has cost colleagues their health or even their lives. Trying to find a silver lining to the pandemic is difficult. My hope is that going forward the pandemic will serve as a stimulus for honest, effective and synergistic dialogue between patients and healthcare staff.
Dr Conor Lyons is an ophthalmology resident at Royal Gwent Hospital, Newport, Wales