The pandemic hit my rheumatology practice like "a tidal wave"

11 March 2021
Professor Anisur Rahman, one of our consultant rheumatologists.

The last year has had an enormous impact on everyone – we’ve heard from health staff working on the front line of the pandemic, in ICU and high dependency units, and we know how great an impact it’s had for many people living with underlying health conditions like arthritis.

Professor Anisur Rahman, one of our consultant rheumatologists, tells us about some of the big changes and challenges he’s faced this year, and how his patients have always remained at the heart of his work and inspired him to keep strong throughout.

“Overnight, all my clinics were converted to telephone consultations only”.

When COVID-19 arrived, everything changed very rapidly. The out-patients area of my clinic was converted to a PPE storage area and the nation was in lockdown.

I had never believed that it was possible to manage rheumatology patients effectively over the phone. When asked why, I always stressed the importance of examining joints and having face-to-face interactions.

My father has often quoted “necessity is the mother of invention”, and this has proved to be true this past year. My colleagues and I discovered that with creativity and energy it is possible to do far more things over the telephone than I had imagined.

Patients know their own bodies. One can ask them to describe their joints and range of movement. It will never be quite as good as a face-to-face encounter but equally it may be more convenient for a patient than a long journey to a hospital for what may be a five-minute appointment.

I imagine that the future will be a mix of telephone and face-to-face appointments and that telephone appointments will be more appropriate for some of the patients, some of the time.

“Sometimes my phone call was the first time my patients had spoken to someone for days.”

The major downside of being unable to see patients was that it was difficult to recognise and manage those who were undergoing flares of disease. The normal scenario of reporting symptoms to GPs and/or being sent up for an urgent appointment became impossible.

Many of my telephone consultations were sobering – people stuck indoors with pain, perhaps home schooling, perhaps afraid for their jobs or homes. Many times, I have found myself talking to people about subjects well outside of their rheumatology diagnosis and trying to provide some comfort. I don’t know how often I succeeded.

The suffering caused by the pandemic and the lockdown for people with arthritis goes far beyond COVID-19 itself.

“I’ve frequently been asked by patients, what can I do about my pain?”

There is no easy answer. Many musculoskeletal physiotherapy services have been paused or adapted to on-line video sessions.

Many operations have been cancelled which means that there is a long waiting time for surgery, such as total hip or knee replacements.

Therefore, many patients are living with chronic pain - and increased anxiety.

If you are in this situation, contact your GP and/or community pharmacist services. They are providing on-line and telephone consultations in which drug and non-drug methods of helping pain can be discussed. The Versus Arthritis website also has more information on looking after your wellbeing, managing your pain at home and staying active with arthritis.

“I have had the vaccine and so have my parents who are in their eighties.”

Since January, many of my consultations have revolved around COVID-19 vaccines – are they safe, is one preferable to another and do we advise them for people with arthritis?

There are many excellent information sites available, including the Versus Arthritis vaccine FAQ webpages, but in a nutshell, I tell patients that I recommend any of the available vaccines for anyone invited to have them, unless they have a history of severe allergic reactions.

No rheumatic diseases are contraindications to having the vaccine and neither of the two vaccines in current use are live.

I have been shocked and disheartened by how many people have been affected by vaccine disinformation. I would never advise my parents to have something dangerous, and having had COVID-19 myself, I never want to have it again.

“We are human beings with our own fears for ourselves and families and vulnerable relatives.”

It has been a really hard year for NHS staff. As well as our own fears, we were coping every day with the fears of our patients. Like many others, I was redeployed to front-line Covid service. The memories will be with me always.

I do believe, though, that I will come out of this a better physician.

A week after I served on the front line, I tested positive for Covid and developed a fever. I was scared. It was the height of the first wave, and I had seen the worst that COVID-19 could do. The Prime Minister, a month older than me, was in ITU.

My illness proved to be rather mild in the end but during those nights I understood, in a way that I had never understood before, how frightening it can feel to have a disease and not to know how things will turn out.

“I find that I can empathise with patients in a different way from before.”

During the sleepless anxious nights when I had COVID-19, I found myself remembering my patients and how they coped with difficult diagnoses and chronic diseases.

I remembered one brave man, who always comes to see me with his wife - a lovely couple. Thinking of them gave me some comfort and courage. A few months later, I had a telephone consultation with them and made a point of thanking them for inspiring me with their bravery. My patient replied:

“No doctor, you and your colleagues are the brave ones. You put your lives on the line for others”. And I wept. It is a privilege to look after people like this. But I was only required to be brave for a short time. Many of my patients are brave every day. I will remember.

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