Inside the DIY Long Covid Clinic • Republic Medical

Inside the DIY Long Covid Clinic • Republic Medical

Most patients can be managed by their GP and local network of other specialists and allied health.


While working on the COVID-19 ward at St Vincent’s Hospital in Sydney, Dr James Zhang visited regularly New long covid clinic After opening early this year.

He saw that much of the treatment most COVID-19 patients needed was within the purview of GPs.

The clinic had a waiting list of several months, and the team was “burned out” by the overwhelming demand. This annoyed Dr. Zhang.

“My wife tells me that I am a very upset person. But what usually bothers me also happens to a lot of other people. I have at least a little bit of motivation to try and deal with this problem.” Medical Republic.

To address this large gap, Dr. Chang opened a long covid clinic in June at the Shire Family Medical in Sydney alongside practice owner Dr Gary Franks. He says that GPs are particularly well-suited to treating the enigmatic condition given its extreme need for empathy during treatment.

“We know our patient’s story, we know their history, and we can travel with them over a long period of time. And we’re a lot easier to get to than a hospital.

His experience has given him insights to share with other GPs seeking to manage the condition.

Diagnosis and evaluation

Dr. Jang initiates an initial rapid telehealth assessment to assess a patient’s eligibility under the WHO definition of prolonged. If patients qualify, they complete the Yorkshire COVID-19 Rehabilitation Screening Questionnaire to determine the severity and impact of the patient’s symptoms.

“We use that as a starting point that we can then review in three to six months to see what their progress looks like,” says Dr. Zhang.

A telehealth call and Yorkshire screening questionnaire is undertaken prior to the in-person consultation, at which point an appropriate assessment is made. Dr. Chang says this usually lasts 30 to 45 minutes and is intended to rule out any complications and other serious comorbidities.

Dr. Chang depends on St Vincent’s Long Covid Clinic website To guide his selection of blood tests and investigations. He also highly recommends B Clinical practice guideline for the assessment and management of adults with post-acute sequelae of Covid-19.

treatment

Dr. Chang says there is no one-size-fits-all treatment for the long-running coronavirus. The literature review has been published in The Journal of the Royal Society of Medicine identified two main groups of symptoms Long linked to the Corona virus. The first was Fatigue, headache and upper respiratory complaints. The second group was multisystem complaints such as persistent fever and gastrointestinal symptoms.

scalpel Research that appears in 2021 published that 203 showed prolonged COVID-19 symptoms recorded across 10 organ systems. These issues include neurological dysfunction, hair loss, brain fog, itching, menstrual changes, bladder control problems, and sexual dysfunction.

According to another article in BMJAnd the Patients with COVID-19 are a great value Input from a primary care physician. Dr. Chang agrees and says the treatment requires a “very personal” approach.

“There is no one magic pill or one treatment that can make everyone better but the least we can do is take on all the cases that can really be treated by GPs and maybe leave the more complex cases to the hospital clinic. Even if it is just a matter of rolling the ball, to get on coordinating care happening, working on investigations,” he says.

Case Study

Dr. Chang cites a case study of an asthmatic patient who had the virus in January of this year. After the infection, the patient experienced shortness of breath and fatigue, and was using the nebulizer more than usual.

“On the face of it, one could easily increase the inflators and monitor. But our role is to run a long list of investigations to rule out any other diseases. When we did the patient’s blood tests, it turned out that she had a huge D-dimer as a result,” says Dr. Chang.

They performed a CT pulmonary angiogram and found that she did indeed have two very small peripheral pulmonary embolisms in her lungs.

The patient was referred to a pulmonologist and is now taking anticoagulants.

Long covid DIY clinic

Shire Family Medical initially opened a long Covid clinic only for existing patients. The most prevalent symptoms were fatigue, shortness of breath, exacerbation of asthma symptoms, and brain fog. Mental health problems are also common.

Dr. Zhang encourages other GPs to start a long Covid clinic but to “manage expectations and empathy,” as the disease can follow a similar course to other challenging chronic conditions such as chronic fatigue or fibromyalgia.

He also says it is essential to reach out to local allied health professionals and professionals to create a referral network.

“You never know what you’re going to get, so you want to take a very broad approach, with a very inclusive mindset about what’s going on with the patient. Ask ‘what affects them the most?’ What other serious illnesses do I need to rule out? What other general health measures can I improve through their lifestyle, exercise, diet, and diabetes? “

The long covid clinic is the factoring of mixed billing into the patient’s circumstances including if the long covid has affected their finances and ability to work. Subsequent appointments may then require a mental health care plan or a GP management plan which are ‘somewhat reimbursable’.

“If you had a 30-45 minute consultation, with proper work-up, took the full history and took the time to sort out their issues, subsequent appointments to do a mental health care plan and a GP management plan wouldn’t take long at all,” says Dr Chang. “.

Great demand for treatment

Recent modeling by the Menzies Institute suggests that there might be Up to half a million people are sick with COVID-19 in Australia. Despite the numbers, there wasn’t much drive behind it General practitioners are responsible for treating COVID-19.

“It may be another symptom of how the federal government may have devalued GPs and failed to adequately compensate GPs for the time they spend on the comprehensive care we can provide. That’s clearly very much needed,” he says.

Dr Chang hopes Shire Family Medical’s long Covid clinic will inspire other GPs, but he isn’t setting himself on any pedestal.

“At the end of the day, this is just something I do as humbly as a GP, as anyone else. We just give it a try and let patients know we’re here for them through thick and thin,” he says.

You can listen to the full interview here.


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