Stories from the coronavirus frontline – Dr Jonathan Bennett, Respiratory Consultant, on managing uncertainty

In a series of posts giving a frank account of experiences on the NHS frontline, Sally Williams hears from Dr Jonathan Bennett, Honorary Professor of Respiratory Sciences, University of Leicester, Respiratory Consultant at Glenfield Hospital and Chair of the British Thoracic Society – the Respiratory Consultant we’ve been hearing from each week during the pandemic. This is what he said on 5 May 2020.

I’ve been feeling rather flat over the last few days. Multiple factors come into play but much of it reflects the ongoing uncertainty over what the next few weeks hold. I’m not sure where I’ll be working from one week to the next. This week, I was allocated to one ward to provide cover for a colleague, and the following day I was moved to a different ward.

Planning in an uncertain world

The emergency rota has altered, reflecting that the volume of COVID-19 patients is reducing, which is good news. But it’s impossible to plan in this context. I want to give attention to our cancer clinics, but it is exceedingly difficult to plan the rota for the next few months. We don’t yet know how many wards will be required for COVID-19 positive patients on an ongoing basis and where COVID-19 positive and negative patients will be streamed.

Normally, a physician’s work is quite structured. Our on-call rota is planned for the year and we know when clinics will be held, and how many patients will be seen. Now it’s all up in the air. The uncertainty of that and the implications for planning makes it disconcerting for me.

Nobody is quite sure how we re-start normal services. How do we catch up when we’re uncertain how other services, like imaging, are restarting? If there is a second surge of COVID-19, it will probably come in September, October and/or November, which is just the time when winter pressures are ramping up. Can I start thinking about the team taking time off now? Our staffing levels are already depleted by people ill or self-isolating. At the same time, we need to give thought to integrating systems of follow up for COVID survivors, whilst trying to get on top of the backlog.

Fatigue is setting in amongst staff. Some parts of the hospital have been relatively quiet during the pandemic and are raring to get going again. But they require input from parts of the service that have been working flat out. So, for instance, whilst surgeons may be keen to restart their services, the intensive care teams are knackered. How do we build in recovery for these teams whilst simultaneously getting services up and running again?

Different ways of working

We will have to find ways of working differently. I mentioned before that my work computer has no camera or microphone, so it doesn’t support use of Zoom, Microsoft Teams or the like. We really need our computer systems to support videoconferencing with both patients and professional colleagues. We also need two screens – one to talk with patients and another to access imaging, results and letters. It also means having a strong Wi-Fi signal across the hospital. I’ve only just got a telephone with a hands-free facility, which allows me to speak with a patient whilst simultaneously writing notes.

There’s a great deal of nervousness over virtual consultations, particularly where they involve sharing bad news. We are asking patients due to attend the cancer clinic if they would like a face to face consultation or a remote one. Most people have at least one face to face visit. As a physician, you have to be pretty rigorous about setting the scene during a remote consultation – in other words, being clear upfront where cancer is the most likely diagnosis. It also involves managing the dynamic between the patient and their relative, who is often in the background or listening in on speaker phone.

The personal touch is so important when giving a diagnosis that can be frightening. Patients who attend the cancer clinic are taken into a room after seeing the consultant, to give them space to think about what they’ve just been told and any questions they might have. Not being able to shake someone’s hand or give them a little hug after they’ve received bad news will be really hard. Those things mean a lot to patients and staff.

‘NOVID hour’

The ward where our COVID-19 patients go has introduced NOVID hour – a ‘no COVID’ hour, in which staff can free their minds from issues relating to coronavirus. I recently joined colleagues for this, where we sat down, in a socially distanced way, to talk about each other and our favourite places. The ward is essentially a temporary staff ward, staffed by bank and agency doctors and nurses, and staff seconded from other parts of the hospital. The team comprise colleagues who represent the full ethnic diversity seen throughout the NHS.

We might not be able to visit our favourite places for a while but taking time out to learn about each other and our different cultural backgrounds, has really helped team cohesiveness. We haven’t had a single staff member leave that ward. It also helps me to manage my own uncertainty, serving as a reminder that we’re all in this together.

As told to Sally Williams

Image: Gerd Altmann from Pixabay