06 May 2020
We are incredibly proud of our members as they support the work being done against COVID-19. The pandemic has rapidly affected how rheumatologists are treating patients, with many redeployed to the frontline and changing the way rheumatology services are delivered. In the first of a series of blogs, we speak to two of our members about how their working lives have changed and how the lessons learnt will alter clinical practice for rheumatology in the future.
Dr James Galloway, consultant rheumatologist at King’s College London, has been redeployed back to the wards, is involved with the clinical trials around COVID-19 and recently recovered from contracting it.
“I can’t remember the last time I did a rheumatology clinic. It must be only around six weeks ago, but time has been a complete blur. At the beginning our team talked about how we could still deliver rheumatology, reducing some of the clinical activity and just seeing the emergency cases in person, moving some of the services online, and variations in working patterns.
“Within a week everything turned upside down. We had to stop almost all face-to-face rheumatology clinics except one session a day for absolute emergencies and everything else moved online. The speed of change was very sudden.
“I was redeployed to a COVID-19 ward and the numbers of people coming in and how it escalated was shocking. I’ve been working a lot on the respiratory wards and the respiratory team have been fantastic. In the first few weeks they worked tirelessly to deliver everything; it was astonishing. There’s been amazing camaraderie in the hospital. King’s has a legacy of being a major trauma centre, so our emergency planning here was very good.
“For me I’m on a rota. The rota includes normal day shifts, 9-5, then you rotate through to doing on-call, which are long days, and night shifts. Because there are lots of consultants working in sequence, I’m only having to do a night shift every few weeks. I normally spend a lot of my time working on research into rheumatology, but I’ve now switched all my efforts towards COVID-19.
I’m involved with the RECOVERY clinical trial and the Gilead remdesivir trial. The speed with which these studies got up and running was incredible.
“During this all I also caught COVID myself. It’s a very unusual disease and quite distinct to anything I’ve had before. I had a cardiac complication, so briefly had to be admitted. The relief of recovering, particularly when I got past day 10, was huge.
“For rheumatology, I think there are going to be changes that are very long-lasting. The move to virtual clinics has opened our eyes to the potential. The future remains all up in the air because we don’t know what’s happening with the virus, but we will look at what we’ve learnt from this and how we can do things better and differently in the future.”
Dr James Bateman is a consultant rheumatologist at Royal Wolverhampton NHS Trust. As well as working on the COVID-19 wards, the team rapidly developed a video that was sent via text message to rheumatology patients about their risk level for COVID-19.
“Initially we stopped doing all outpatient activity for routine and follow up patients and switched to virtual consultations using a mixture of telephone and video for urgent cases. It’s the first time we’ve used video consultations in rheumatology for our patients.
“The second big change is that as part of the Trust’s response to COVID-19 we were all deployed to clinical areas. I was deployed to a diabetes ward that has been turned into to a COVID ward and I’ve been looking after patients as a consultant general physician. It’s been interesting to be back on the wards and I’ve developed positive relationships with a much wider group of colleagues who I’ve been working alongside.
“I did that for a couple of weeks but now I’m back doing telephone-based consultations with rheumatology patients. We’ve been trying to work in other innovative ways and one of the things we’ve done, which we think is a world first, is develop a video for patients and send a link to it in a text message to 12,000 patients.
“The video was produced in-house and gives information to patients about how their risk of getting COVID-19 is affected by their condition or the medications they take. We used the BSR risk scoring system that had been designed for doctors and produced a patient-led risk score instead. Patients receive a text with a link to the video which is hosted online. It offers them digestible, simple information about the risks.
“Developing this helped us understand how we can communicate with our patients more effectively. Before, we’d only used text messages to send appointment reminders and we’d never used video in this way to help inform patients. Basically, this has changed the way we communicate.
“Pre-COVID we would’ve never done something like this, but the situation is making everyone adapt and move quickly. It would normally take us around three months to get approval for a patient-facing video, but this was approved in a morning by a senior Trust representative. We turned everything around and it was out to patients within four days. We’re all adopting lean and flexible ways of working.
“We’ve been sharing our work with teams in other hospitals and we worked alongside the charity the Hibbs Lupus Trust, who’ve been giving us guidance on how to communicate with patients. It’s been a collaborative experience and we’ve managed to share our work widely with The Lancet’s preprints with a commentary to follow in the Lancet Rheumatology shortly.
“We’ve also produced a video guide with one of our nurses around biologic injections and sent it out to patients via text message to support the rest of the information. It’s been nice to work somewhere where everyone is responding to challenges positively. We work across two sites, so we’ve been using Microsoft Teams for the first time to meet remotely. Now we’ve done it and worked out how to share files, we’ll be keeping it up.
“We’ve learnt so much during this process and we’ll definitely be keen to carry on with seeing patients virtually where appropriate, but we do need to think about the economic impact that this would have. We’re also hoping to remove a lot of the red tape in terms of how we innovate and change services, rather than carrying on doing the same things.”
Huge thanks to James and James and all of those who are sharing their experience of working during the pandemic. A free wellbeing support helpline is available for NHS staff from 7am-11pm seven days a week: call 0300 131 7000 for confidential listening from trained professionals and specialist advice, including coaching, bereavement care, mental health and financial support.