Ishwinder Thethy
Dr Ishwinder Thethy is a Fellow of the Royal College of Physicians of Edinburgh. She is a Consultant in Acute and General Medicine and works at the Royal Infirmary of Edinburgh.
Correction: In the interview, Thethy states that she has had one month of annual leave, in fact she had only had one week of leave.
Details
- Date of interview: 9 October 2020
- Archive reference: RCP/RES/2/12/9
- Interviewer: Daisy Cunynghame
Timestamps
00:26 - The effect of coronavirus pandemic on working hours and practices
03:01 - Comments on availability of Personal Protective Equipment (PPE)
05:23 - Complexities of treating patients during the coronavirus pandemic
09:11 - Thoughts on the long-term impact of the coronavirus pandemic on health and mental health
11:05 - Long-term effects of the coronavirus pandemic on the NHS
15:02 - Government responses to the pandemic
18:24 - Public response to the pandemic
20:14 - Personal experiences of contracting probably coronavirus
22:53 - Effect of the pandemic and lockdown on home-life routines
24:40 - Mental health impact of the pandemic on medical professionals and personal experience of losing family member to coronavirus and being unable to be with family at that time
28:13 - Views on finding information surrounding the pandemic
Transcription
Interviewer:
Could you please start by just saying your name, your membership status at the college, and your medical specialty?
Ishwinder Thethy:
I'm Dr. Ishwinder Thethy. I'm a fellow of the Royal College of Physicians in Edinburgh, and I'm a consultant in acute and general medicine, and I work here at the Royal Infirmary in Edinburgh.
Interviewer:
Thank you. Could you describe how the coronavirus pandemic has affected your working hours and your practice?
Ishwinder Thethy:
If I'm to reflect on this question, just going back to the beginning, it was obviously challenging and our entire organisation went through complete restructure and this was, of course, to accommodate provision of a COVID admissions unit. Also, we were working very hard to make sure that when we admitted patients downstream, that we had separate working streams where we had COVID positive wards and COVID negative wards. That has obviously had an impact on non-urgent care. The things I found challenging at the start was that there were daily changes that were being brought into effect by management and these were [not] necessarily communicated down to us as service providers in real time. Consequently, as time has gone on, there has been an increased pressure on our specialty to provide more availability to be able to give COVID admissions unit 24/7 cover. And then we also have to have a robust rota where we are second on call in case a colleague has to self-isolate or has to go off unwell.
So, I have found myself working more weekends, particularly at an increased frequency and just having given availability. Normally we have to give availability for different clinical sessions, I have five different things normally and now I find that I have to give availability for seven things and just looking at the last eight months I’ve only actually taken one month of annual leave and it seems impossible until February to be able to take some annual leave. So, in that way I feel the work hours have increased overall and the way that we work has also been changed in terms of providing COVID admissions unit cover. Turning up to work and having to make sure you're inadequate PPE (personal protective equipment) and at the start really making a choice if I was reviewing patients in clinic, over the telephone, whether I had to just bring a patient up to the acute suite and risk them being exposed to the virus versus delay in diagnosis and management of any new or chronic condition. So those are the kind of things that have changed and are challenging.
Interviewer:
Thank you. Have you experienced any lack of medical equipment such as PPE, or if not do you have any comments on the shortages that have taken place?
Ishwinder Thethy:
I think at the start when we were only just becoming aware that COVID was here on home ground, I did have a personal experience. Often, we provide cover in the accident and emergency department where we review patients who've been sent up by general practitioners for assessment to hospital, and we had a designated area in the emergency department and that had now become the area where we were going to review suspect cases of COVID.
So, initially there was no official stance on having to wear PPE and so I encouraged my junior doctors to make sure that they had scrubs on for work, which is not something that we normally do in our specialty. I remember going to a meeting in scrubs and we were talking about the provision of scrubs for our trainees and for ourselves as a consultant body. And we were told that we had to be mindful and be positive role models to make sure we weren't taking scrubs away from theatre staff or intensive care or anaesthetics, yet we were also expected to be on the front-line assessing people with suspected COVID.
In the end, I think, as a group of physicians we decided that we would buy our own scrubs. That was something at the beginning that just felt like, you know, there was no acknowledgement or care in terms of making sure we were safe. So, we all bought our own scrubs, and I remember going to buy them and having a laugh because the person at [Hewitt?] said to me, “Do you think you'll get reimbursed?”, and I laughed out loud and I said, “I very much doubt that”. And as time has gone on, in fact, I think we've gone the other way with making sure now that people have the basic PPE and the clinical work areas, and I haven't experienced any medical equipment shortages to be honest.
Interviewer:
Thank you. Without actually giving names, can you think of any examples of patient’s experiences, which you can share, which illustrate the impact of coronavirus?
Ishwinder Thethy:
I was reflecting on this and it's really difficult to just hone in on just one individual patient journey. I think what comes to mind, and if you just give me a second to pause. If I think about, pondering on the complexities of treating coronavirus as you've worded it, in general, it's just the fact that we don't actually have a definitive treatment option.
At the start we were expected to man the COVID admissions unit, and we have a telephone that we man and people will call from A&E or other specialties. So, there were lots of phone calls about suspect cases and what to do and that was complex in terms of having to make a decision on a patient that you haven't actually reviewed yourself. And considering that you were bringing them into an environment where you could possibly cohort them with somebody who was positive and the patient could have been negative. Yet they're coming as a vulnerable group of patients with comorbidities and higher risk of being worse off if they contract COVID. So that was complex in itself, and then on a personal level having to assess people in the COVID admissions unit, there was very much having conversations saying, “You're here, you've got chest symptoms, we need to make sure you don't have coronavirus. In the meantime, we'll be giving you supplemental oxygen making sure you're well hydrated and rationalizing some of your medications”.
But internally I felt very, very helpless because I couldn't initiate definitive treatment and that is rare. And I was hoping for the best for most of the patients, and the other complexity that we faced in our specialty is this, there's an increased expectation to approach anticipatory care planning with patients and as an acute physician, I’ve always felt that this is counterintuitive actually. When you've met a patient for the first time you've not built up a relationship, like people who manage their chronic conditions or general practitioners. They've now come to you in extremis and they're looking to you as a physician with hope that you're going to get them better within reason and hopefully get them home. So, in the same conversation you're explaining how you're going to try and get them better but then you have to talk about death and dying, and I really find that counterintuitive unless it's absolutely necessary.
So those were the complexities on a broader level. I can't think of just singling out one patient in particular. It was a theme that was recurrent and sometimes still remains recurrent. And of course, then not having a family able to come in with the patient and visit them, making that judgment call of “Actually, you know what, call the family and give them PPE, let them sit with the patient”. And it's really difficult to tell someone over the phone that their loved one isn't doing well. So those are really complex things that we've had to face now.
Interviewer:
Thank you. Do you have any comments on what you think the long-term health implications of coronavirus are going to be?
Ishwinder Thethy:
I made a few pointers on this. We are already seeing people presenting with worsening mental health issues, so anxiety and depression. We've seen a lot of increase in admissions already from complications due to increased alcohol dependence, a lot of self-harm. And, of course, then having you know put a stop gap initially on non-urgent care or follow-up of chronic health conditions. We have seen late presentations and late diagnosis of non-COVID pathology, which has gone from being curative management to possibly just managing and palliating, for instance, cancers and stable diabetes deteriorating. So, people would come in [with] complications of diabetic complications, which we’re very good at minimizing and managing with regular follow-up with chronic conditions, but because that has been pushed back, we've seen some of that emerging. And then of course we occasionally have to, because I do the general medical clinic, you get referrals about patients who think they may have had COVID or have had COVID and then they've got these long-term sequelae, or feeling fatigued, feeling not quite right, feeling short of breath. And I know that there is work underway in the organization to have the proper structure to follow these patients up, but again I think it will take months, if not years, to just completely appreciate the long-term effects. But those are the ones I can think of just now.
Interviewer:
Thank you. In a similar vein, do you have any thoughts on the long-term implications of coronavirus on the NHS? In terms of how provision of care is structured, funding structures, things like that?
Ishwinder Thethy:
So, I think again the cumulative impact of COVID on [the] NHS, the wider social care network, and society, it's going to take months if not years for us to actually properly quantify this. We've already seen, like I mentioned before, a disruption in the way that we work and even before COVID actually hit us, we were trying to balance real-time budget restrictions with becoming creative, providing more with minimal [resources]. And at the start, despite this, we did radically mobilize to provide care and respond to this pandemic. I think going forward, especially coming this winter, we still have chronic issues with bed capacity, and I think we fear what might happen if we have a bigger second wave of this virus. Added to that the usual seasonal flu, and other winter bugs such as norovirus, and then we're only just coming out of trying to start back on non-urgent care, planned cancer treatments, elective work streams. I think these were already, you know, waiting lists were growing and I think that now this is even being pushed back further. So, we're going to have to deal with that long term.
The other thing that I’ve noticed is that at the start we had expected that we would be overwhelmed, but I wonder whether the message that we gave kept the public away to the point that we were underwhelmed. And I think, even now, speaking to people who are friends or colleagues who are not in the profession, they find access to emergency care and primary care even more challenging. So, I think these things, you know, we're going to see the effects of increased pressure in the long-term.
We are trying to work in more creative ways, or one of the positive things, if I’m meant to think about this, is trying to do telephone consults or ‘near me’ consultations. And I do the general medical outpatient clinic and since I took my consultant job over the last three years, I was already trying to restructure it so that we could work more efficiently, have either waiting lists reduced and make sure we were seeing the appropriate type of patient. So, I think because we had time to just pause and have a look at all our lists, [we were] able to actively triage again and restructure the clinic such that we have reduced our waiting list and we have picked up which patients would be more appropriate for telephone consults, rather than bringing up them up face-to-face and agreed that maybe return consultations will have more appropriate telephone consults. Still seeing new patients face-to-face, and I think the patients like that they have regular telephone contact with you, and that's also created capacity for me on a personal level to be able to set up a syncope service in the clinic, as a positive example of what's come out of this. So, I think it's early days to actually say but there's some positives but there's a lot of fear of some negatives.
Interviewer:
Thank you. It's slightly one of those impossible questions; you have to predict the future. Do you have any thoughts on the government response to the pandemic? Either the UK government or the Scottish government?
Ishwinder Thethy:
I was thinking about this, and I think we'd be unfair to say that things were not handled appropriately, because actually we were dealing with something that was completely novel. So, I like to believe that everybody tried their best at the start of this pandemic and the government was possibly taking the information at hand and trying to put measures into place to try and curb spread as best they could. Time has gone on and just reflecting on it, there are some things that I wish could have been handled better, like perhaps an earlier response.
I am originally from Kenya, and I travelled to Kenya in February, just before things really kicked off, and I was reassured that actually they had somebody screening people for a fever when you landed. And although you can argue that that hasn't really helped curb the spread, it was an attempt at trying, because they were aware that this was happening in a different part of the world and we travel and it's possible that it could hit their borders.
And I’ve contrasted all along in this pandemic, because my family are in Kenya, how we've been very different with completely locking down. Whereas in Kenya lockdown would perhaps prevent the spread of COVID and try to minimize excess death but it would result in immediate death because people already live in poverty. If you lockdown, they'll die of starvation or hunger. So, the Kenyan government actually adapted a policy of where we're at now. Businesses remained open but reduced hours, curfews were introduced in eateries, pubs were shut and there were very, very [strongly] enforced regulations for people to socially distance. They had provided sanitizers in supermarkets; they made sure that you couldn't go into a shop unless you were wearing a mask and actually they [have been] much stricter in the UK government in terms of holding people accountable when they break lockdown.
So, I wish in the UK, and I believe that our government is trying best, that we could sing from the same hymn sheet between England and Scotland, not give mixed messages. I wish the government would be a bit more transparent with explaining the science behind the measures that they are trying to implement to control this virus, so the public can understand it better. And I really wish that the people who break lockdown face consequences and are accountable for their actions, rather than the threat and they're not carrying out the threat, if that makes sense.
Interviewer:
Thank you. You've answered a bit of this question already, but I’ll ask it just in case you have more to add. What do you feel about the public's response to the lockdown and the pandemic, and particularly in terms of following the regulations that you've talked about from the government?
Ishwinder Thethy:
I think at the start I saw an eagerness, and just even where I live my entire tenement wanted to do something and they wanted to support the NHS and they held a weekly bingo to raise money. So, there [were] real acts of kindness and real concern and a real sort of “We must do this to protect society”. I think what I’ve noticed as time has gone on and during the initial lockdown as well, there were still people who were breaking lockdown in open spaces, hanging out in large groups, and I fear that we're at [a] stage where people are experiencing what I call COVID burnout. They're so done with COVID in their own words and they're reticent to follow lockdown. I can see that if the government doesn't clearly explain the rationale behind, for instance, this new two-week lockdown which to me as a clinician I’m struggling to see, it might delay the inevitable but it's not the long-term answer. So, I’m worried that we're at [a] stage where the public are having COVID burnouts and may not necessarily be amenable to following these measures.
Interviewer:
Thank you. The questions I’m going to ask you next are about the personal impact of COVID on you, if there are any questions you're not comfortable answering please do just say. Have you had or do you know of any colleagues, friends, or family members, without naming people, who have personal experience of contracting coronavirus? And if you're comfortable doing so, can you describe these experiences?
Ishwinder Thethy:
Actually, at the start of this I had symptoms. This was because I’d just come back at the end of February and I’d seen a couple of patients who, using my clinical discretion, I felt I could not explain this, except [that] this was a viral infection. I then developed symptoms. And I remember you know calling my line manager and then being told that if I didn't have a temperature then I should be okay and at that time, we didn't really have a proper case definition. I’d started with developing a sore throat, so I was told if I came to work and they checked my temperature and I was okay then I would be fine. And within three days I woke up in the middle of the night wheezing and I was quite breathless, so it was very clear at that point and I needed to get tested, but I tested late and I do think that although my test was negative, I believe it was a false negative because I know myself and I’ve never been breathless or wheezing. I live far away from my family, so I was very, very concerned because I live on my own and I remember having to prop myself up on pillows sleeping at night because I felt breathless lying flat. There was a fear that the next day, was I going to be here? Because if I deteriorate then it's just me who's going to have to get myself to hospital. And there was fatigue associated with it so just moving from room to room I felt breathless and I felt tired.
I’ve had other colleagues who have definitely tested positive. Actually, a colleague of mine who had symptoms at the same time as me and actually she initially tested negative, as did I and we went on the same day to get tested and then three days later she got worse and she tested positive. And she still suffers from fatigue and breathlessness and needs to have reduced working hours, and I’ve had younger trainees say they were monitoring their oxygen [saturation levels] and they were quite low. So yeah, I have had colleagues who've been affected, and from personal experience I think I got away lightly.
Interviewer:
Thank you. Could you describe how your home life routines have been impacted by lockdown?
Ishwinder Thethy:
That's a good question. Because I live on my own, a lot of my sort of well-being outside of work involves socializing and meeting with people outside of work. Engaging with, going to say the theatre, catching a gig, go and see a film, having dinner in a nice restaurant, doing some outdoor walks and I found that really challenging at the start because I had to come home after a really busy day of work, carrying all of that and really not have that outlet or have somebody to speak to about it. I laugh because often I would say to my mom you know “You're so focused on cleaning the house and you go to the supermarket, and you want to buy every single thing on the shelf.” And I found myself spending my Saturdays cleaning the entire place and then my Sundays were my days in the supermarket, but I would actually spend hours and get to the till and go, “What's the bill? Oh no”. And I laughed with my mom and I said, “I was laughing at you and now I’m turning into you”. So I think it's been hard in terms of, I’ve tried to organize my time off with my walks and just doing household chores or shopping for food but the impact is that I sometimes feel very - I’m not refreshed, because I’m missing the things that nourish me. It's difficult in lockdown when you're restricted and you can't meet with other people outside.
Interviewer:
Thank you. Given everything that you said, in terms of your professional and personal experiences, do you think there's a significant negative impact on the mental health of practitioners, and do you think that the support is there that you need?
Ishwinder Thethy:
I do think that we risk burnout, and I do think that some days the way I feel, you feel a bit helpless and you think “When is this going to stop”. For me as well, I worry about when I’ll be able to see my family next, and I’m carrying anxiety across two continents and I’m seeing the way this pandemic has been managed very differently here to the way it's being managed there. My uncle passed away from COVID in Kenya, and I was unable to go because the border was shut, and I was really worried because my father was in contact with him, so sometimes I really worry more about them than I do myself.
In terms of support measures in place, I think at the start we had the break rooms, we had a place where you could go and sit down and refresh and there is the staff wellbeing that you can connect into. But I think on the ground I still have to be convinced that this support is there and it's more visible and easily accessible. For example, Daisy, I recently started to have really bad breakouts of my skin because of the masks and I’m now on three months of antibiotics and needing topical Roaccutane. I had got in touch with [unclear] health, and it was really good to know that they had provisions in place, and I wasn't the only staff member who was perhaps experiencing this. So, I’d been sending pictures of what had happened with my skin, and they were able to set up a consult with dermatology, and the consult was very good. However, she said to me, “Looking at the pictures you sent in, you probably shouldn't have been working”. And I had to laugh and go, “I wish you just said that when I’d sent in the pictures”. So, it's things like that where I don't think that the organization isn't trying to support us, I just think that the communication could be better.
I do fear that not just me but a lot of other people will feel this will either challenge them to switch on and forget about the things that they deal with but then accumulatively working more hours you know still not seeing light at the end of this tunnel. Not being able to see family that easily whether you're in the UK or they're outside of the UK; this is all going to have long-term impact. and I think that we need to think about that and consider how we can offer more support. I don't know if that answers your question.
Interviewer:
No, that was fantastic. If you need to pause at any point if you want to have a little break.
Ishwinder Thethy:
Yeah, I might just have a cup of like, just a sip of tea. Thank you.
Interviewer:
Thank you. This is the final question. Where do you look for accurate information on the pandemic, and do you have any comments on the use of social media and the internet to disseminate information to the public and to medical professionals?
Ishwinder Thethy:
Where do I look for the information? I often just go to the scot.gov.uk for the updated figures and actually my line manager, I need to ask her because she's been using the tracker where there's daily updates on the number of cases and intensive care admissions. With regards to social media, there's pros and cons as usual and I feel at the start, every time you switched on to any kind of social media platform it was all COVID and it was all doom and gloom. You really have to be very careful with what you take at face value, so I’m lucky that we have a consultant WhatsApp group where we sense check things or we share things that we think will be worth discussing and beneficial.
But I’ll give an example outside of work. I overheard one of my neighbours saying that they thought that this was a complete hoax, that COVID didn't exist, that doctors were “putting any odd crap”, in their own words, on death certificates. And I really felt very angry and I thought, “I work with people who come to work every day, and they're monitored and they have a duty of care to people. We do not make things up and we would be the last people to be in cahoots with a hoax like this because it's turned our world upside down”.
So, I have tried to minimize actually reading a lot on social media about COVID, I speak to my colleagues, and I check in with the scot.gov.uk website and then the kind of press articles I read would be the BBC or the Guardian. But again, I take things with a pinch of salt. And I did also in this pandemic, as the education lead in the department, [invited] a lot of people to have talks with us online, on zoom just to educate us on the research that's going on, and also the effects of COVID. I was able to actually include audiences from Kenya and Kazakhstan. That's my way around it, actually get a group of professionals together and use my stance as an education lead to get professionals talking, not just to us but to our trainees about things that are actually valid rather than relying on social media.
Interviewer:
Thank you. Just before we finish up, is there anything that you'd like to say that you haven’t had the opportunity to bring up so far? You're allowed to say no, it's fine.
Ishwinder Thethy:
I can't think of anything.
Interviewer:
Okay, fantastic, thank you.