The World Health Organization’s (WHO) advice in relation to infection prevention and control measures for healthcare workers caring for a patient with suspected or confirmed Covid-19 states that contact and droplet precautions are recommended for all healthcare workers caring for a patient with suspected/confirmedCovid-19. The WHO advise that provision of appropriate personal protective equipment supplies should be a national and institutional priority.
Members are always advised to follow the guidance in your country in relation to what PPE must be worn and when.
There may be occasions when you believe that it is justifiable not to see a patient without adequate Personal Protective Equipment. Ultimately there is a limit to the risk that you would be expected to put yourself at in order to provide treatment to a patient. You should however consider the GMC’s guidance on this matter a link to which is provided below.
In the section of the GMC’s Covid 19 guidance entitled “Working Safely” the following is stated:
“We do not expect doctors to leave patients without treatment, but we also don’t expect them to provide care without regard to the risks to themselves or others. This pandemic is an unprecedented challenge in which clinicians are understandably balancing the imperative to provide care with their own fears.
We understand that this may lead to doctors having to make very difficult decisions where they have to use their professional judgement.
Doctors will need to consider:
· whether treatment can be delayed, or provided by another team;
· what course of action is likely to result in the least harm in the circumstances;
· whether alternative actions or additional steps can be taken to minimise the risk of transmission;
· whether any doctors or other healthcare professionals are at a higher risk from infection than other colleagues.
You should try to work with colleagues to find the best way forward in the circumstances. Our expectation is that doctors will do their best in the circumstances they face, considering the welfare of the patient and the risk to their own or others’ health to make these difficult decisions.”
The same FAQs go on to say:
“While a lower standard of PPE may increase risk to some degree, doctors would need to consider how to provide care to patients, including whether the available equipment allows treatment to continue.
If having tried and exhausted alternative means of treating a patient you believe that this is not possible without unreasonable risk to you and to other healthcare professionals, you should escalate your concerns, record your decision and how you tried to address safety concerns.”
The British Medical Association are also addressing this issue in detail, and their details guidance can be found in the following link:
In this guidance entitled “COVID-19: refusing to treat where PPE is inadequate” the BMA, in addition to providing advice on raising concerns, take the following view:
“…there are limits to the risks you can be expected to expose yourself to. You are under no obligation to provide high-risk services without appropriate safety and protection. You can refuse to treat patients if your PPE is inadequate, you are at high risk of infection and there is no other way of delivering the care.”
In is clear that employers should be providing adequate Personal Protective Equipment to allow doctors and other health professionals to do their jobs safely. If you are concerned that such equipment is not being supplied, or is in short supply and likely to run out, you should raise concerns in line with the local process for raising concerns within your organisation in the first instance.
If you are asked to see a patient without the appropriate Personal Protective Equipment, each situation will need to be considered on a case by case basis. You are urged to consider the GMC’s guidance on this matter in making any decision. You should of course be prepared to justify any decision you make in the event that this decision becomes subject of a complaint or investigation at a later time. You should also ensure that any reasoning for any decisions that you make are carefully documented.
Medical Protection members who do find themselves subject to regulatory or disciplinary proceedings as a consequence of not seeing a patient because there was a lack of appropriate Personal Protective Equipment can contact Medical Protection to seek advice, support and representation.
Medical Protection has called upon the GMC and employers to provide reassurance that doctors with not face action as a consequence of inadequate provision of PPE. Further details can be found in the following press release: https://www.medicalprotection.org/uk/articles/doctors-should-not-face-investigation-if-they-decide-they-cannot-see-a-patient-due-to-poor-ppe-provision