Adelina McLeod
Dr Adelina McLeod is a Collegiate Member of the Royal College of Physicians of Edinburgh and is also the current Chair of the College’s Trainee and Members Committee. Dr McLeod's speciality is geriatrics and she will become a Consultant in summer 2021.
This interview took place on 7 October 2020.
Timestamps
00:00 Introduction
00:41 The effect of coronavirus pandemic on working hours and practices
00:50 Comments on availability of Personal Protective Equipment (PPE)
09:09 Complexities of treating patients during the coronavirus pandemic
13:14 Thoughts on the long-term impact of the coronavirus pandemic on health and mental health including on the elderly
16:20 Long-term effects of the coronavirus pandemic on the NHS
19:07 Government response to the pandemic
22:37 Public response to the pandemic
25:53 Personal experiences of working through the coronavirus pandemic and effect on role as RCPE’s Chair of Trainee and Members Committee
28:23 Effect of the pandemic and lockdown on home-life routines
29:22 Wellbeing and mental health impact of the pandemic on medical professionals
31:14 Views on finding information surrounding the pandemic
35:05 Closing comments on the positive effects of the pandemic on compassion, creativity, community, and the environment, and how these qualities might be used to tackle health inequalities and crises in the future
Transcription
Interviewer:
So if you could start off by introducing yourself, just telling me your name, your College status and what your medical specialty is.
Adeline McLeod:
Yeah, so my name's Dr Adeline McLeod. I am a collegiate member and I'm chair of the Trainee and Members Committee at the college. I am training in geriatrics and I will become a consultant next summer. So I'm nearly at the end of my training, less than a year to go.
Interviewer:
Fantastic, thank you. So could you describe how the coronavirus pandemic has affected your working hours and your practice?
Adeline McLeod:
Okay, so I think at the very start of it, there wasn't too much of an impact. So I work up in the North East and obviously London and the southern counties got hit first. And we saw that the cases were rising in London and we had a bit of time to prepare. So there was this feeling that we were probably about two weeks behind London. So within a couple of weeks, so I, within my trust, stepped up to be lead SPR with another colleague. We redesigned the SPR rotas. There was more of us on call, sort of four registrars on call overnight, four during the day. And I also built in redundancy into the rota, which they've never had before. Usually there's the minimum staffing you need to be safe there. And obviously when registrars used to go sick, we used to have to scrabble around for cover. Now I purposely built in redundancy because of the risk of people getting sick and also the risk of people having to be off and isolate and that sort of thing. And then we were on that rota for a couple of months. So mainly we were doing 12 hour shifts. So you either on a day shift or a night shift or you were off. And we worked that for a couple of months. But I have to say the sort of wave of cases we were expecting didn't really happen in terms of, yes, we got a lot of coronavirus in the hospital, but everybody, it was really strange in that people seemed to stop coming with strokes, people seemed to stop coming with heart attacks. There was one day I went on to one of the stroke rehab wards, they had nine patients out of a 30 bedded ward and that is just unheard of. And so in a sense, we didn't quite get overwhelmed as we were expecting because yes, there were, I think the worst sort of about 60%, 70% of my ward had COVID patients on there, but people really stayed away from hospital. Another thing was that we redeployed a lot of doctors away from kind of more regular work. So we just as a trust really focused on what the essential emergency service should be. And doctors stopped doing outpatient clinics. They stopped going to managerial meetings. They stopped doing sort of the more kind of routine stuff. So there was a real prioritization of tasks in order to support the emergency effort. And so there was actually a lot more doctors around than there ever has been. And then we just sort of waited and waited and waited and the sort of influx just didn't happen as we were expecting. We were expecting to see scenes like we'd seen on the news in Italy, where people were just using sort of emergency wards and putting people wherever they could to ventilate them. I suppose we were expecting the worst. And then after that, we sort of redesigned the rota again to just reduce some of the frequency of the long days, get a bit of normality back. And now we have a sort of hybrid rota in that there are a few extra on call days, there are a few extra registrars around in order to build that redundancy in, again so that we don't have to rewrite rotas overnight again if we do, as you know, as we do get second waves and we get more sickness amongst the staff.
Interviewer:
Okay, thank you very much. Do you have, have you experienced any shortages of medical equipment at all? Or do you have any comments on shortages in general?
Adeline McLeod:
So I really don't think where I was that we did have a particular shortage with PPE. My trust, I mean, my trust now has its own PPE factory, which is good. But I don't think where I was working in particular, there was a huge shortage. I think nationally there was a perceived shortage. And I think that it did, you know, people were very scared at the time. People were very anxious about what the virus was going to be, what their lives were going to be. There was a big unknown about it. And I think some of that fear was possibly channelled into there's a lack of PPE. But really, I didn't feel that there particularly was. There was, I did sort of look around at staff and sort of felt that we could have been better at how we used the PPE. So for example, a little bit later on in the pandemic, the Royal College of Physicians London produced an infographic called Spaces and that was about sharing patient assessment in order that you reduce how many times you're going into a patient room. And I think in the very early days, we hadn't quite adapted our practice. So I would see consultants going into a room bringing the FY1 with them to see the patient, which is, which they do because they always do that and it's a learning opportunity. But I just had to stop and challenge that and sort of say, is that really necessary? Is it necessary to bring the F1 in with you? And when I did my ward rounds, I had a mechanism where I went in with the PPE, my SHO stood outside, I would come out the room and then dictate what I wanted that person to write in the notes. There's pros and cons with each approach, but at the time, in order to preserve and use PPE most effectively, I felt that there were ways that we could have implemented a little bit earlier in order to sort of use it more intelligently. But I absolutely accept that behaviour change is incredibly difficult. And humans are animals of routine and often things just happen because they're not necessarily thought about in advance.
Interviewer:
And you mentioned that your trust has a factory for PPE. Was that something that was in place long before COVID?
Adeline McLeod:
No no no no, so that was put in response to, you know, during coronavirus. So I think obviously on the global market, PPE was available, but was available at a cost. And those costs did escalate quite rapidly. And I think so, the trust I work for is, it's an interesting trust. So it's one of the few trusts in the country that are not in debt. And so it is a trust that is quite dynamic and creative in how it gets revenue. And obviously revenue is really important for trusts to make because any profit you make, you can actually reinvest in your services. And so quite early on, it started producing PPE, mainly so that we had a reliable access to it, but could also use that revenue to reinvest in stuff that we need.
Interviewer:
Thank you. That's very interesting. So without naming individuals, are you aware of any particular patients' experiences you could share with us to give us a bit of an idea of what the real life impact of coronavirus is?
Adeline McLeod:
Yeah, so I suppose, so I'm a geriatrician. And so the older population, so the older age group, are the age group that have the worst outcomes due to coronavirus and all of the epidemiology tells us that. People are also frail because of their background comorbidities that existed pre-COVID. And so a lot of the people admitted to my ward with coronavirus were unlikely to do well from the outset, but also unlikely to do well if we did anything invasive. And so identifying people ill enough to die, communicating that with relatives and supporting people through that was… became really important. There was a real tragic case where we had spouses on the ward with coronavirus. And I think the wife died about three days before the husband. And then you just think that son who's just lost both of his parents in the same week. And I think what was really challenging for us was the lack of access to relatives. So normally when somebody's dying, it's a process that you take the patient and the relative on. So somebody gets admitted, you get to know them, you get to know the relative, you start giving warning shots, you say, oh, well, the next 24 hours, but I'm not sure. And you just start early preparation for that patient dying and you bring the relative along with you, the relative supports that patient through. And you get to know the families often as well. Normally when people are dying, there's open visiting and you actually get to know sort of the extended family. And as a doctor, having those interactions, getting to know people in that way, getting to know their story and their life as sort of told through their relatives, is really something that I cherished. And unfortunately, during coronavirus, we weren't able to do that. We had to restrict access for relatives in order to try and keep them healthy. And lots of relatives had really hard choices. So they may have been elderly themselves. They may have spouses who had to shield and they had to choose between their loved one that was dying and their loved one that was alive. Some people as well, especially quite early on with the quarantine, etc. If you had been exposed to somebody with coronavirus, people had to choose whether they went to see their loved one whilst they were still alive or they went to the funeral. And so that was really difficult actually, the journeys that the relatives had to now go on, the decisions that the relatives had to make, and you really felt that. And you could only talk to them over the phone really. And so I think that was incredibly hard, emotionally exhausting as a team. And we really did, we really did miss that relative input because the relatives and loved ones of your patients are so much part of their therapeutic journey and their journey within the hospital. It's really difficult to do it without them.
Interviewer:
Thank you. So do you have any thoughts on the long-term health implications of coronavirus, either for your specialty or for medicine more generally?
Adeline McLeod:
So I think the answer to that is I suppose we still don't really know. Some people seem to get the coronavirus infection and have sort of an episode and they recover and they're fine. There's more evidence that people are suffering more kind of long term sequelae from COVID, whether their first episode was particularly bad or whether they had a mild case, but long-term sort of fatigue. Colleagues who've had COVID are saying, you know, they used to run 5k, absolutely no bother, and now they're struggling to run 500 metres. And so there will be, I think, long-term impacts on the workforce, especially if we do have chronic illness as a result of COVID. And I also think we're probably standing on the precipice of the mental health crisis as well. If you look at evidence from military and when you look at sort of the PTSD studies and scenarios, it's not, it doesn't usually hit right at the time. At the time, humans are very good at crisis management - we need to get on with this. And it's actually when people stop and start to take stock and start to reflect, when the urgency isn't there anymore, that's, I think, when people start to struggle. And so I am concerned about that. And I'm concerned about the mental health, especially of my elderly population. I'm scared about the impact of social isolation on the elderly because there are huge risks in terms of the impact of social isolation. It's as bad for your health as smoking 15 cigarettes a day. Idle brains – you know, if you don't use it, you lose it. And I think not having that contact, not having that connection, not having conversation, I think we're also going to probably see, we may see a rise in dementia after this. I am starting to see people kind of come through where they haven't had that regular input with somebody and so they have neglected themselves quite significantly. Depression and anxiety is quite high in some of the people that I'm seeing now. And so I do worry about the impact of social isolation on the elderly. And if you think about it, a lot of people who are elderly are still isolating and have been since March, and it's been months and months and months.
Interviewer:
Thank you. So I was wondering if you have any thoughts on the long-term impact of coronavirus on the National Health Service itself. So in terms of, do you think things are going to change in the way that treatment is delivered, the way that things are structured, the way that funding is applied?
Adeline McLeod:
So I do have a couple of thoughts on that. So coronavirus has been a huge catalyst for change and change has happened quickly. And we know sort of prior to COVID that the NHS changed, but it took a while to, in order to affect any change. So I think that one of the things that coronavirus has done is given us an urgency to change and things have happened very quickly. We've collaborated really well with, across departments, across trusts, but also across industries - so the NHS and the military engineering partners have all kind of collaborated to meet the response. I think one thing that the coronavirus has highlighted is that there needs to be, I think, a balance in the NHS between efficiency and resilience. And you can't, I mean, the NHS is publicly funded and obviously we need to make sure that we use public money wisely. But a really, really efficient system has everybody working at maximum intensity at all times. And one of the downfalls of an efficient system is it's not very resilient. And in order to build resilience, then you have to have redundancy and redundancy is not efficient. So I do think we need to reimagine what we want from the NHS. And I think resiliency is something that has been sacrificed on the altar of efficiency over recent years. And I think that's something that does need to come back in to the NHS because we need an NHS that can adapt quickly to the needs of the population and also adapt in a way that doesn't harm other people. So it's not fair to take resources away from one population of patients to give to the other. You just have to have those resources sort of available to draw upon if needed. We're obviously seeing the impacts of the fact that cancer screening hasn't happened. The outpatient appointments for people presenting with their first lumps and bumps haven't happened. And I do worry about the impacts of that as we actually pulled all the resources to the emergency response.
Interviewer:
Thank you. I wondered if you had any comments on the government response to the coronavirus pandemic, either the UK government or the Scottish government or both?
Adeline McLeod:
Without getting in trouble?
Interviewer:
You can pass if you want. You can always pass if you want.
Adeline McLeod:
So I think, I think the difficulty I have had with the government response is lack of clarity and lack of clear leadership. And I am concerned about the growing narrative that we currently have, which is blaming public and individuals for the resurgence of coronavirus when actually the public were following, generally following, the rules. So you were encouraged to go back to work, you were encouraged to go out into the pubs and clubs and things like that, people did so. I think the response of, go to a pub but socially distance and expecting drunk people to be able to socially distance is possibly a high expectation. And so I suppose that's really what concerns me. It didn't feel, it hasn't felt, like the rules are particularly clear. I'm an incredible, you know, I feel like I'm an intelligent individual and I work in healthcare and even I struggle and have to reread and read and reread these rules again and I'm not quite sure exactly what I'm allowed and not allowed to do. I think the one thing that they didn't get right in the start was testing and I think if we'd had a better response to testing some of the stuff that we saw in terms of the care home crisis may not have happened. And I think one of the downfalls was trying to keep, one of the mistakes I think, was trying to keep that testing centralised. I think that we have really good public health networks locally and I think that if we had allowed the local public health bodies to work with their local agencies in order to rapidly upscale testing, I think that they would have responded and they would have met that challenge. So I think, my criticisms would be in the early days, the testing just wasn't upscaled as quickly as we needed it to be. And I think, coming out of lockdown, I think that some of the advice and leadership has been lacking at times. And I'm also slightly concerned about the lack of discussion and debate within the Commons. So we need our political system to work for us, be accountable. And we can only do that with the involvement of everybody who has been voted in, rather than just one party taking broad decisions.
Interviewer:
Thank you. So my next question, you...
Adelien McLeod:
[coughs]
Sorry.
Interviewer:
That’s alright - I'll edit that bit out. So my next question you've touched on already, but I was just wondering in terms of what you think of the public's response to this. So in terms of following the rules, but also how much of this in terms of social distancing and less physical contact between people do you think will stay in the longer term? Do you think there's a real change to the public sort of interacting with each other in the longer term?
Adeline McLeod:
Yeah, I think so. I generally think the public response has been incredible. We asked people to stay at home and be locked down and potentially at the risk of their jobs and their livelihoods and they did it and they understood and they did it for the greater good and they did it in order to protect each other. And I feel like communities have really come together. In my community, very quickly, there was a network of volunteers set up for people who were elderly or socially isolating. The local shop did lots of deliveries. And I feel that as a village, we really came together to support people in the village. I feel by the by, actually, people have probably, the majority of people have followed the rules. It's just that, everybody went to the beach at the same time, but they were allowed to go to the beach, when you see those photos from Brighton Beach sort of thing. And I understand, you've been locked down, Boris says you can go to the beach, you get your family packed up, you get there and it's really crowded. And what are you going to do? Are you going to just say, oh, we'll just have 5 minutes or are you going to get your car and turn back? And I understand people getting to that beach not expecting it to be as crowded as it was. I understand that kind of thought process and they were actually following the rules. I think that it has changed how we interact with each other and I think people are generally following social distancing and wearing masks. I do feel sorry for school children because this is a real huge change for them. And I'm sure it must be just really, really strange to have your childhood in a scenario where people can't touch and hug and you can't sort of play tag with your friends and things like that, that must be really odd. But I think, people do have a feeling of responsibility for each other. And I think the majority of people understand that they live in a community and you have to, y’know, follow rules in order to keep yourself and your community safe. And I think most people are prepared to do that. I don't think I'd have much criticism for the public.
Interviewer:
Thank you. So the next questions I'm going to ask are about the personal impact of COVID on you. If there's anything at all that you don't feel comfortable answering, then please feel free to say so. Have you had, or do you know of any colleagues, friends or family members without naming individuals who've had personal experience of contracting coronavirus? I was just wondering if you're comfortable to do so.
Adeline McLeod:
No, it's fine. So I've been really lucky. My family haven't had coronavirus, although my husband would swear that he has, but his test was negative. I'm not going to say man flu. [laughs]. But no, so my family have remained safe. I have had, there's been colleagues at work that have had coronavirus. Obviously, it's been an anxious time, seeing them, but they've all pulled through and I haven't had any sort of, personal tragedies due to COVID. I suppose how it's affected me, so I took over as chair of the Trainee Members Committee in October. And then I was just getting to learn what I was doing and then suddenly in March, everything sort of kicked off with coronavirus. So I've had a baptism of fire in my sort of leadership role, having to really work together with agencies such as the GMC, Public Health England and the Academy of Medical Royal Colleges in order to make sure that the guidance was relevant to trainees, had trainees welfare at the heart of it. I remember one weekend where I had a phone call from the president of Royal College Edinburgh on the Friday to tell me that everybody's exams were going to be cancelled on the Monday and I had to sit with that all weekend and not tell anybody. And then the announcement came on the Monday that trainees exams were going to be cancelled. And I suppose sort of rapidly acting at that level was a huge learning curve for me. It has, I mean, as a personal development thing, it's been, it has, I have learned lots of skills very quickly. It's meant that I've had less time with my committee and I would much rather develop their skills. But that's the plan for this year, this year coming. I discovered quite rapidly that lockdown lifestyle is not much different to my normal lifestyle. I have a three-year-old, so we don't go out much. And so it wasn't necessarily that hard to adapt to the lockdown restrictions. The one thing that was difficult was just really missing my mum. So me and my mum would see each other probably once every couple of weeks. She would see my daughter. And that was really difficult. And then eventually when I could see my mum not being able to hug her was really, really difficult. And so going through a hard time without having that contact has, has been emotionally, it has been difficult, but there's people in worse off situations. So I just really thank, count my blessings if I'm honest.
Interviewer:
Thank you. So obviously you’ve said quite a bit about the professional and the personal side of things. I wonder if given that, if you feel like the support for medical practitioners themselves is sufficient, particularly in the context of mental health at this difficult time.
Adeline McLeod:
So I think there is a lot of focus on it at the moment and I think at the moment the resources are there. The Thursday night claps, I think were a real morale boost. And I wonder whether actually going into this winter, this winter is actually going to be harder than the initial peak because we're trying to, so there has been a real effort to not reduce any of our normal working services, so it's sort of business as usual and deal with a pandemic at the same time, whereas back in March it was stop everything, there's a pandemic coming. So I think that is going to be difficult this winter and I fear that physicians as a group of physicians, GPs and emergency care doctors are going to be at the absolute forefront of that. And I think that we were already facing a recruitment crisis and we're already quite burnt out a lot of the profession. And so I do worry that how that will increase people's decision to stay within the profession or choose to train in the profession. And again, I just hope that the resources that we have available now are maintained, probably need to be maintained for the next three to five years because as I say, it's not when the crisis hits that people wobble, it very much is after.
Interviewer:
Thank you. So this is the final question. I wondered where you look for accurate information on the pandemic and do you have any thoughts on the use of social media and the use of internet to share information with the public and within the profession?
Adeline McLeod:
Oh, that's a really interesting question, actually. So right at the start of the pandemic, I was consuming everything that I could. So I was going on social media forums. I was looking to the Royal Colleges. There was obviously the John Hopkins resource there as well. I was reading the news and it was actually, my mental health was suffering, I have to say, because I think there was just so much information, there was a drive for me to get so much information. And I suppose if you're just focusing on something that is terrifying, it does start to really impact you. So I think maybe after about four to six weeks of, into the pandemic, sort of in the UK really, I made the decision to just stop. And so I stopped looking at social media posts about the pandemic. I stopped watching the news about the pandemic. I just kind of had to. And then a lot of my information actually then just kind of came from work. So work had a daily COVID bulletin e-mail. I would read that and I would limit my, you know, I would limit what I would read to that really. It told me what I needed to do for my work. It told me a bit about what was happening. sort of across the country and that sort of small snippet is what I needed. The Royal College Edinburgh had a really good sort of synopsis news feed and I would look at that from time to time and for me that felt somewhere like somewhere that was trustworthy. I think the issue with social media is that the role of social media is not really as a news outlet. So social media is designed to basically capture your attention and sell your attention and sell your attention to advertisers. And the algorithm feeds you what's going to capture your attention and what's going to keep you on the websites. And so I think that, as human beings, we're naturally programmed to worst case scenario, read into sort of stuff that is fearful. And I worry that if people are getting most of their news from social media, they're going to get whatever triggers them the most. So if they're particularly fearful about COVID, that's the sort of things that's going to come up and come up and come up. If you think COVID is a conspiracy theory, then you will just be fed more and more and more about COVID being a conspiracy theory. And you don't get a broad mix of views and opinions. And so I think they call it the rabbit hole or something like that. That is my fear with social media. And I think that is more and more how people get their news, thinking that is the premise of social media channels, which it really isn't. Social media is there to sell advertising.
Interviewer:
Thank you. So just before we wrap up, is there anything else that you wanted to say that we haven't covered?
Adeline McLeod:
So I suppose what I would like to say is coronavirus, when I sort of look at what has happened globally and what has happened in my community, I think that it has really, it has really brought out, for the majority of people, it's really brought out the best in what we are as human beings. I think we've seen an incredible amount of compassion. I think we've seen a lot of creativity as people have worked and thought outside the box to solve problems. And I think that it has really increased our community ties and community bonds. And I think that after the COVID pandemic has gone and rescinded, because it will, these things do burn out eventually. I think that we need to keep a hold of those ideas and principles and feelings because we do have some real big world problems to solve. The impact of lockdown on air pollution has been incredible and I think 9 out of 10 of us breathe unclean air and it has significant health implications. I think as doctors we need to become more active in solving big world issues such as the climate crisis, environmental destruction, plastic pollution, all of these because they all affect our patients. We can't just deal with the individual patient in front of us and the conditions that they come to us with because there's so much out there that's actually influencing that. And health inequalities, I mean, I live in the North East, which is one of the most deprived areas in the UK. And I was listening to the lecture by Professor Marmot the other day. And it's just really sad to think that we've just lost a decade. Health inequality has grown over the past decade. The poorest 10% of women, and that will be women within the North East where I live and I work, their life expectancy has actually gone down. And so I think that post-COVID, we really need to harness the collaborative efforts, creative thinking and compassion that it's brought out within our society to actually start to solve these really big world problems.
Interviewer:
Fantastic. Thank you very much.