Catherine Labinjoh

Dr Catherine Labinjoh is a Fellow of the Royal College of Physicians of Edinburgh. Other positions within the College include Council Member representing the constituency of Central and Tayside, and member of the College’s Equality, Diversity, and Inclusivity Group. She is a Cardiologist and works in NHS Forth Valley Hospital.

This interview took place on 19 May 2021.

Timestamps

00:00 Introduction

00:42 Changes to work patterns

01:36 Long-term impact of COVID on physical and mental health

02:59 Long term impact on NHS

06:04 Government response to pandemic

08:55 Public response to pandemic

10:31 Vaccines

13:24 Personal experiences of friends and colleagues contracting coronavirus

15:05 Effect of the pandemic and lockdown on home-life routines

17:12 Wellbeing and mental health support given to medical professionals

19:09 Misinformation on the pandemic

21:26 Closing comments

Transcription

Interviewer:

So if we could just start by you please telling me your name, your college membership status and your medical specialty.

Catherine Labinjoh:

Yes, so my name is Catherine Labinjoh. I'm an elected member for Council in the Royal College of Physicians in Edinburgh and I represent a geographical area called Central Scotland and Tayside. And my medical specialty is cardiology.

Interviewer:

Thank you very much. So when we last spoke six months ago, we talked about how the pandemic was affecting your working hours and your everyday work. And I just wondered has that changed over the last six months?

Catherine Labinjoh:

Yes, I think it has quite a lot. Interestingly, at the start of the pandemic, we were, quiet wouldn't be the word, but the way that our routine work was really different and certainly diminished at the beginning. We didn't see as much of the routine cardiology and even general medicine things. Now I would say we feel very much back to normal and my working patterns are really dominated by my business as usual, you might say, but business as usual in the context of the pandemic. So some things are a bit more difficult in terms of scheduling and pathways and mostly because of social distancing.

Interviewer:

Thank you. So something else we spoke about six months ago was your thoughts on what the long-term health implications of COVID would be on patients. So both in terms of mental and physical health. So I wondered if you had any further thoughts on that?

Catherine Labinjoh:

Yes, I'm not sure I know the answer even yet, but since we spoke, obviously there's been much more development around the concept of prolonged symptoms and impact from COVID, what's sometimes called long COVID. And the difficulty for us at present is that thatseems to be quite a heterogeneous group. So a mixture of physical and emotional and mental symptoms and some more physical symptoms for some people that are very clearly related to the things we understand about the pathophysiology of COVID, so lung disease, and then some things that are perhaps much less easily related to that and obviously the psychological impacts and mental impact. And we haven't quite got a structure of how we're going to look after those patients because they have symptoms which seem to be across lots of different body systems and lots of different manifestations. So, yes, it's definitely here.

Interviewer:

Thank you. So something else that we spoke about six months ago was what you thought the long-term impact was going to be on the NHS. So in how care is delivered, if there are any changes to the way you were approaching or treating patients or the bigger picture of how the NHS is funded and structured. And I wondered if you have any thoughts on what those long-term impacts might be?

Catherine Labinjoh:

Well, I think thinking smaller and perhaps locally, just reflecting on my local experience, it's pretty clear that we won't go back to the way we delivered care before. And I think most of that's really good. So a lot of patients are really appreciative of being able to use different methods of being in touch, such as being on the phone or using the Near Me application. So that will still exist, definitely. We just have to work out how we're going to blend clinics to do that. And on top of that, we're also seeing that there were perhaps some people that we were seeing in certain ways, it was just habit and maybe we didn't need to see them at all. And that let us think about that. Or that the intervals at which we would see them are different. We haven't got it fully fledged here in NHS Forth Valley, but patient initiated follow up, I think, is something that will definitely grow because you know the patient is the expert in their own health condition. So allowing them to say when they need to see you and how, I think those things will be, should and will stay. There's clearly the tail of people who we haven't been able to stay and see, we're still playing catch up. So that's going to impact on us, I think for quite a long time. And again, locally, we've had a really big impact from the change in practice in general practice. And I know working in general practice has been really challenging, you know, delivering care in primary care has been difficult. And so how we interface, I think, needs to be different and how we are going to share the care of patients in the future will probably be a bit different. And we're trying to provide a bit more all in the round when we see people doing everything we can all at one stop to avoid people pinging back and forward. We're trying not to impact and lean more heavily on primary care but equally that's difficult when you're in a setting where you don't want to bring people into hospital. So I think that is still to be decided and that part of it I think will be a national phenomenon to work out how we're going to work together around that. I think sort of expedited by the pandemic, but not just about the pandemic, there will be and continues to need to be a revision about how we manage what we call unscheduled care or unplanned care between the settings that are closest to patients, between primary care, between minor injuries and people presenting at hospital and the emergency department. I don't think we've got that quite right. I'm not sure anybody has got it quite right, but I think that's going to be a place that's going to be worth investing in. We definitely need to continue to develop those services.

Interviewer:

Thank you very much. So I wondered if you had any thoughts on the government's response to the pandemic, particularly over the last six months in the way that they've dealt with the various issues that have arisen.

Catherine Labinjoh:

Yeah, it's a big question. And I suppose my responses would be, is a kind of very personal one. I think we've done okay. I guess that's what I would say. We've done okay. Clearly, the vaccine thing, the vaccine rollout, has been really good and really strong. And we're even addressing now some of the difficulties about access for some people about vaccines. So on the whole, really good. But those pockets of people who are disadvantaged in the same ways we've seen disadvantage across the piece in COVID, that's being tackled. I'm not quite sure that we did the contact tracing element, the pure public health element of it, as well as we could have. And I'm sure we'll reflect on how we might do that better and perhaps be a bit more supported to do that locally and more nimbly - that's the in word of the pandemic, isn't it? So to do that. I suppose many people feel that we responded to the events that were leading up to the second lockdown rather slower than we might have. But it's easy with hindsight. Everyone, including me, is an expert in predicting that things were going to be really difficult towards the end of the year and the new year. I think medical professionals and others started to talk about that a lot and with some anxiety towards the end of the year, perhaps a little bit in advance of that, this second lockdown. So that's a bit slower than we might have liked. And that's definitely had an impact. Overall, I don't know, it's hard to say, we're in a position where we have a death rate that's kind of astonishing. And if you'd asked me 18 months ago whether we'd be facing something like that, I'd have been really shocked and maybe still a bit shocked. We might need to have that meeting in six months time to see. And in terms of… I think the… most of the communications part from Scottish Government has been pretty good and quite clear for us. So as good as it could be. So yeah, so probably that's about all I would say about that at this time.

Interviewer:

Thank you. So you've touched on this already, but I wondered, following on from that, if you have any thoughts on the public response to the pandemic over the last six months. So thinking in terms of social distancing, mask wearing, following the sort of guidelines that you've just been talking about.

Catherine Labinjoh:

Well, I think it's been very good and very good considering actually the complexity of the situation that we're dealing with. So something completely new. We didn't really know very much about transmission at the beginning. We didn't know how to influence and impact on transmission. We were asking people to do a lot of things all at once. And inevitably, mixed messages came out. So at the beginning, the kind of obsession with being able to catch COVID by touch was very big and people were very fearful of that. And we, you know, encouraged them to be fearful of that mechanism. I think we feel that's less of… important now compared to airborne transmission. So we've sort of changed the messaging and that's been true about many different parts of the messaging in COVID and that must be really difficult for people to understand. So on the whole, I think people have paid close attention and tried really hard to do the right thing. Of course there will be pictures and pockets of different activity, but I think broadly speaking people have done very well in a really difficult situation.

Interviewer:

Thank you. So of course the really big change that's happened since we last spoke six months ago is the vaccine or the vaccines. And I wondered if you had any comments on how that has impacted on your work having this vaccines available, but also do you have any comments on the way the rollout of the vaccines was handled at all?

Catherine Labinjoh:

I think having the vaccine has been amazing and I did not believe that we would have it at the time that we did. And I was very happy to have it and felt really privileged to be at the front of that queue as a healthcare worker. So I think that's been managed well. I think the messaging's been quite clear. I think we've sought to protect the high priority groups and I think that's right. Although perhaps we missed the risks for people who were at home who were connected to healthcare workers. And I think there's some evidence coming out that actually those groups of people were perhaps at higher risk than we thought. So that's been good. Was I disappointed not to be getting my second dose at four weeks, which is when I thought I was going to get it, having had the first dose? I think I was, and I saw a lot of real distress and anxiety from coworkers feeling let down about that. But it looks as though that was a really very good decision, actually. So, you know, it would have been easy to criticise at that point, but it looks like that was a good decision to hold back on some more first doses and spread, so hold back on second doses, sorry, and spread first doses. So I think that's been quite clear. There's been an amazing response from people who've wanted to help. So we haven't, I think, had a shortage of people to administer vaccine and clearly we've had good provision of vaccines. So I think that's worked really well. Again, the same lesson we come back to with COVID each time though is about equity of access though. And there's no doubt that it's easier for some people to access the vaccine than others, even if it's your turn. So if you do have family commitments or you're a carer and you live in a difficult area and you're being asked to come, an area that's difficult to access, you're being asked to use two buses and et cetera, et cetera, and you may be fearful, then I think that's been really difficult for people. And I'm really pleased to see that we're putting a lot of effort into that now to make sure that we're making it as easy as possible for people to do the right thing.

Interviewer:

Thank you. So as last time, I'm going to move on to looking at the personal impact of COVID on you. And just to say again, if there's anything that you're not comfortable answering, just say and absolutely no pressure at all. So without naming individuals, since we last met, has anyone in your family group or friends or colleagues contracted coronavirus? And if you're comfortable talking about it, would you be willing to do that?

Catherine Labinjoh:

So I've been really blessed in my immediate family. I feel blessed that we have not had COVID. And I was absolutely thrilled when my dad got his vaccine. But we've been safe, so that's great. We were impacted by a COVID outbreak in our ward here in the hospital, which is not a secret. And that was extremely tough, much tougher than I thought it would be. Many patients were affected, many members of staff were affected, and many members of staff had their families then affected. And it had a massive impact on how we worked and it made delivering cardiology services at a time when we really needed to keep going with that extremely challenging. Everybody, as always, rose again to the challenge. It occurred at the start of this year at a time when people were already very tired. And even then we asked more of them and they still delivered. So that was amazing. But the effects on the team, their own wellbeing and their families was big. And I think we're still recovering from that. So yeah, so that's been one of the biggest impacts, personal impacts for me through the actual virus, yeah.

Interviewer:

Thank you. So are your home life routines still being impacted by COVID? And is that sort of less so than it was the case six months ago?

Catherine Labinjoh:

Yeah, well, I'm not in my underpants at the back door anymore, you'll be pleased to hear. So that's good. I think we're still doing general measures, but we're much less anxious. But at the start, our children were at home with us. So my husband also works in medicine. So we were really conscious of not bringing it into the home to others. Now we've both had the vaccine and it's just us at home. So in a sense, that feels a bit safer. We've really had a very restricted social life, just like everyone has. So that's been interesting. But you know, we've fallen foul of many of the temptations, or at least my husband has of Covid. He's still making bread, amazingly - it's good bread so I'm not complaining. So doing a few things differently. We're eating quite well, probably gaining a bit of weight. So we're doing things differently domestically in that way, you know. because we're not seeing people and not socialising. But in terms of the fearfulness and the regimen and the routine around trying not to catch or transmit COVID, we're not really too impacted by that anymore. We both commute a little bit to work. And in fact, the commute was terrific during the early part of COVID and even up until quite recently. But now with release of lockdown, I imagine other people are returning back to the workplace and schools are back and so on. So traffic's busier again. So maybe I'm still, and maybe I'm grouchy when I get home again. I'm not sure.

Interviewer:

Thank you. So something else that we talked about six months ago was the mental health support that is in place for medical practitioners. And I wondered, is the support structure much the same as it was six months ago? Are there any new resources that are now available?

Catherine Labinjoh:

There's nothing particularly new or more robust I'm aware of. There's a lot of stuff out there online so there's some information, but I think I probably underestimated how big the emotional impact would be. And I'm very fortunate that I work in a pretty close knit team and we have really a lot of peer-to-peer support within our team and that's worked really well. But it's still really, really hard. And I think that just the exhaustion, being tired, doing new things, doing everything differently, dealing with each other's anxiety and patient's anxiety, it's really tiring. And I'm not sure what you can put in place around that to support people other than making sure they don't do too much of it all of the time. There is a kind of dose, a dose with a relationship here. And I think that's been underestimated a little bit. So people took fewer holidays, committed more time, did extra things, maybe worked in the evenings and weekends when they didn't as much before, did new things, worked in new areas. I think that's mentally very draining and really, really, really tiring. And I'm not sure we really were able to put in what we needed to to make that a lot better for people.

Interviewer:

Thank you. So this is my last question. I'm interested to know about access to information. So again, this is something we touched on last time is how the general public as well as yourself access information. And do you have any comments on sort of misinformation or the sort of the scare stories that might be circulating out there about COVID and particularly the vaccine as well?

Catherine Labinjoh:

Yeah, well, I suppose we live in the age of misinformation. And there appears to be misinformation about everything. And that is really difficult, isn't it, where to get resources from? And that's one of the things we've been thinking about actually here in Forth Valley about how we can help people signpost them, as they say, to really reliable sources of information. Although conspiracy theories are still rife even about things that we would consider to be very mainstream and not contentious. For me, I've actually found the Scottish Government’s NHS Inform and the Scottish Government website pretty reliable, pretty in-depth information and very useful. So I've gone to that for things that are related to the pandemic. I'm just like everyone else in that I'm completely confused about what I'm allowed to do, where and when kind of domestically as things change. And particularly because I've got family in different regions and my children in England and so you're never quite sure how that all matches up and what they're able to do and what you're not to do best not to do very much really and just keep it quiet. So that's been difficult but I've found getting access, information, fairly routine through robust medical sources and the college of course has had a fantastic set of resources around COVID. So I haven't found that too difficult but and the misinformation thing, well, you know, you just have to not look at it - it's everywhere. But yeah, I think what I have found interesting is there's been some specific advice about how to tackle that, not to go head-to-head with people really who sometimes have these very strong beliefs that are perhaps not to us, don't seem logical, but they're emotionally well connected to. So it's been interesting learning how to try to provide people with the best information you can and still maintaining really positive relationships with them.

Interviewer:

Thank you very much. So we're essentially done now. But before we stop, is there anything else that you would like to say or anything that I haven't asked you about that you want to bring up?

Catherine Labinjoh:

No, not really. I mean, I suppose given that we're speaking the way that we are, I kind of take it as read that I'm so much more comfortable on this kind of platform, Zooming and Teams and so on than I ever thought I would be a year ago. We're all so good at it. And I think that's revealed some things, not just for the way that we interact with patients, but the way we interact with each other. And there were some concerns that we would miss a lot of social contact. And we have, we do need to have better social contact. But in fact, there have been some things that I've been able to participate in that I wouldn't have been able to participate in before because they're in this format. We use Teams within the NHS and some meetings that I've attended that have had better attendance than ever before because people have been able to connect like this. So I suppose that's a really important thing as part of legacy about going for the future - how are we going to maintain a really good functioning hybrid model? It's not always easy to have a mix of face to face and people online, but online definitely allows access for people. And I'm thinking particularly internationally, you know, the world's got a lot smaller because we can do it like this. But the only other thing is I'm standing up because I realise I now have to alternate between sitting down and standing up because I spend far too much time sitting down. So yeah, that would be the only other observation.