COVID-19 on the Frontline: Dr Jacob de Wolff

TMLEP Member, Dr Jacob de Wolff talks about life on the front line during the COVID-19 pandemic and how this can impact claims in the future.

Dr de Wolff works at a North London NHS hospital that was one of the first hit by the wave of COVID-19 cases to sweep into the United Kingdom.

Given the unprecedented effect this pandemic has had on life as we know it, TMLEP wished to discuss some of these effects of COVID-19 with those fighting it on the front line:

What changes have you seen to your Trust since the start of the pandemic?

“We’ve seen a complete change to our acute care processes. The emergency department has been split in a COVID and a non-COVID area, and the same for the wards, most of which have changed to ‘cohort’ patients with a confirmed coronavirus infection. General physicians from all departments have been covering inpatients wards on a new rota and the consultant rota has significantly increased weekend staffing. I and the other acute physicians are now predominantly working on the high dependency unit, which has expanded to deliver CPAP.”

What efforts are being made by your Trust to maintain patient safety?

“Our existing escalation processes for deteriorating patients remain in force (e.g. NEWS2, the medical emergencies team), clinical incident reporting continues as normal and infection control measures are applicable to all contacts with patients who might have COVID-19 to prevent the in-hospital spread of the virus.”

What do you think people need to be aware of about the pandemic?

“It is almost inevitable that diagnoses will be delayed or missed due to diagnostic overshadowing by COVID-19. It is extremely difficult to exclude pulmonary embolism clinically in those with COVID-19, especially if there are other risk factors for VTE (Venous Thromboembolism), but it is also not feasible to perform CT scans on every patient. Communication with patients and their families is being hampered by visiting rules in hospitals, which is compounded further by language and cultural barriers. Many other clinical presentations have become very scarce and there is widespread concern that this will lead to delayed diagnosis of non-COVID19 pathology. Medical staff are learning to cope with this profound change in circumstances, and there is much uncertainty about what is going to happen to healthcare (on an individual and systemic level) in the next few weeks and months.”

Is there a more unseen part of the pandemic you believe needs highlighting?

“COVID-19 has brought into the public eye the process surrounding DNACPR (do not attempt CPR) decisions, and my experiences on social media have shown that there is widespread misunderstanding of the potential benefits of CPR, reasons why it might be inappropriate, and the legal position of patients and relatives in the process.

Some of the common issues I have seen arising are that difficult conversations have to be conducted over the telephone, and many members of the public express surprise that DNACPR is ultimately a medical decision. Examples of poor practice in some areas have created the impression that medical staff are “rationing” or “discriminating”.

Treatment escalation planning has become an urgent issue for those who might not benefit from CPR but also from ICU admission or even from hospitalisation. In an ideal world these decisions would have been made a long time ago, prior to the hospital admission i.e. in people living with multiple severe comorbidities or those with obvious poor physiological reserves.

It has also been very encouraging to see doctors from other specialties support the hardest-hit teams and I would like to highlight this.”

TMLEP hope the above can provide some insight into the working world of frontline staff during the COVID-19 pandemic and wish to thank Dr de Wolff for his insightful comments. The long-standing effects on patient safety and the clinical negligence sector are yet to be seen, but TMLEP will be keeping abreast of these providing updates as and when appropriate.