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Author: Edward

4th Year Medical Student

Why Reflection Is Important For Your Medical Journey

The Infodemic outbreak: Public Health vs social media    

Public health was improved from the last pandemic, as public awareness changed for the better. However, the COVID-19 pandemic has brought with it a plague of misinformation that damages public health, that has gone viral. Social media, to an extent, has enabled this spread of hysteria and conspiracy theories. These have ranged in the amount of harm caused but have led to the damage of 5G towers in the UK, alcohol poisoning in Iran, and xenophobic theories concerning Chinese takeaways. WHO have labelled this as “the Infodemic”. (https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19–8-april-2020

Misinformation

Sources of misinformation can spread rapidly, are not fact-checked, and can damage patients’ health–belief, resulting in non-adherence and confusion with public health policies. However, health officials often take time to prepare statements which creates a space that these rumours quickly fill. As people become misinformed, the workload of public health officials increases, as they must inform the public as well as debunk the myths and conspiracy theories.

Social Media as a health resources

The public using social media as a health resource is not a new phenomenon. Patients often seek advice on online support groups such as Nancy’s Nook for endometriosis and support groups for parents on vaccinations for children. Patients can share experiences and information on how to manage the condition, which can have beneficial effects on their health. 

However, the most recent pandemic is a lesson that public health must work with social media to encourage the public to use reliable websites, as information on these support groups is not always evidenced-based, especially concerning vaccinations. However, during the Infodemic, visits on the NHS website have increased from February to March and peaked at 3.4 million on the 17th March 2020. (https://digital.nhs.uk/coronavirus/nhs-digital-tech-analytics

Conspiracy theories

Conspiracy theories are nothing new to pandemics. When Cholera struck the US in the early 1830s, citizens blamed the Irish immigrants; and there was anti-Semitism associated with bubonic plague in 1349 in Europe. However, social media allows a faster spread of these rumours. Social media can have a positive impact on the distribution of information. For example, people in China were able to utilise social media to raise awareness of the doctor Li Wenliang, a whistle-blower of the COVID-19 in Wuhan. (https://www.bbc.co.uk/news/world-asia-china-51403795) It also has been able to keep people well informed about the coronavirus tracker on Facebook. 

Therefore, Public health needs to continue working with social media to keep people best informed. It highlights the potential promise of social media in managing patients’ ideas about their health and expectations of their healthcare.

Social media are here to stay

Furthermore, to both limit the spread of misinformation and to optimise the dissemination of public health information, public health should work with social media. Social media will continue to shape our patient’s ideas, concerns and expectations in the post-Covid era, and clinicians are naïve to think otherwise. The Infodemic is a lesson that we need to work closely with and not against social media. Hopefully, through a cohesive relationship between public health and social media, we will be able to recommend and direct patients to reliable sources of information.

Limited Resources: results in a change of the discourse of DNARs 

Cautionary tales from affected countries have warned that limited resources can result in ethical dilemmas. For example, a limited number of ventilators result in decisions on whom to allocate them to. As a result, clinicians have changed their approach do not resuscitate forms (DNARs). (https://www.resus.org.uk/faqs/faqs-dnacpr/

The pandemic and DNARs

These forms are a medical decision and are made by qualified clinicians who take on board the patient’s wishes. Clinicians recommend DNARs for patients who would not receive a survival benefit from CPR, which can be a traumatic experience. COVID-19 has resulted in increases in DNARs as doctors are increasing the frequency of the conversation of end of life wishes with patients. Also, healthcare professionals are asking patients about their wishes regarding treatment and resuscitation in A&E. These conversations are precautionary and allow patients and staff to be best prepared and enable transparent care. However, the conversation can induce anxiety and therefore, healthcare professional should discuss DNARs with an appropriate tone. 

However, reports from AgeUK highlight that a lot of elderly patients are feeling pressured to agree to DNARs. (https://www.ageuk.org.uk/latest-press/articles/2020/04/age-uk-response-to-dnr-forms/) The charity has branded the practice as verging on unethical. It is vital that clinicians consider the patient’s wishes, and that no patient feels pressured to have a form.

However, there is often poor education on resuscitation and the DNAR forms, as even the name aides to misconception. The reports from AgeUK also highlights that clinicians should take time to discuss DNARs, to improve patients and families understanding. As well, patients’ expectations need to be managed on a national scale to expect a discussion about their wishes on resuscitation in any medical consultation. It will help to alleviate the fear surrounding the conversation and improve our approach to it. Unfortunately, more patients are receiving DNARs now, even though they have always been needed. It begs the question why weren’t these forms in place before the COVID-19 outbreak? It highlights that perhaps we have shied away from consultations about end-of-life care, resulting in a lack of preparedness. A lack of readiness can often lead to traumatic experiences with CPR, which is effective, around ~20-30% of the time.(https://mycares.net/sitepages/reports2019.jsp )

Clinicians need to improve their practice by having transparent conversations about end of life care. It is a lesson for the post-COVID era that better patient education on DNARs is required, and increased encouragement about an open discussion about end of life care. 

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The Forgotten Frontline: Transformation change of social care

COVID-19 has struck the UK’s social care, where silent outbreaks have spread throughout care homes. There are currently over 11,300 care homes in the UK, of which there are approximately 400,000 residents, and small businesses own the majority. There is a separation between social care and the NHS, which puts care home staff and patients at risk. 

Furthermore, staffing shortages have been problematic due to anti-immigration policies and staffing illnesses in care homes. This means there is also a reduced capacity of staff who are often overworked and underpaid, with 50% receiving less than the minimum wage. (https://www.theguardian.com/society/2020/apr/19/half-of-frontline-care-workers-paid-less-than-living-wage) The staff assist patients with activities of daily living, which means established relationships are built over a long period. 

As the attention of staff focuses on supporting patients who are infected with COVID-19, the basic care needs of unaffected individuals are potentially compromised. Also, it is difficult to imagine the emotional strain on the staff, residents and families as the pandemic silently sweeps through these care homes.    

The lack of support for staff, patients and families is a moral failure which reflects a backwards approach to social care in the UK. The UK’s adult social care budget has decreased by 9.9% between 2009/10 and 2016/2017.( https://www.ifs.org.uk/uploads/publications/comms/R143_Chapter1.pdf

The UK’s ageing population

Furthermore, the UK has an ageing population and therefore increasing demand for social care. All of these issues coupled with the effect of COVID-19 point towards a crisis in social care. But perhaps the needs and requirements of nursing homes could have been anticipated and avoided? COVID-19 has highlighted that our old care model, which focuses on responding to need, needs to change to a model that anticipates need. 

The King’s fund outlines our old model and argues that a drastic transformation change in our healthcare model is necessary. For example, we need to reduce secrecy and care based on visits and develop a transparent healthcare system that tracks changes in the individual’s health. (https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/transforming-the-delivery-of-health-and-social-care-the-kings-fund-sep-2012.pdf ) More evidence suggests that there is long term recovery of patients with COVID-19 with effects on the neurological, renal and gastrointestinal systems; the demand for care will only be exacerbated by the current pandemic. (https://www.today.com/health/coronavirus-long-term-health-covid-19-impact-lungs-heart-kidneys-t178770 

The necessary change in social care

There needs to be a transformative change in social care. Our healthcare system is in its 70s, and there have been little reforms along the way. Social care is underfunded, and there needs to be better integration between care homes and the NHS, more respect for the care staff, and better care for our patients.

The article discussed a select few points about how COVID-19 could change healthcare on a national scale. However, it did not consider the global implications of the pandemic. There is uncertainty over the future that the post-COVID era will bring.

At the time of writing this article, the vaccination against COVID-19 was only in its beginning, so we decided to avoid this topic altogether.

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