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Australia Rising concerns among parents that children with respiratory illnesses are not being seen by their GPs

01:25  14 june  2021
01:25  14 june  2021 Source:   abc.net.au

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This is despite rising concern among parents and some other medical professionals that sick kids aren't getting treated by GPs and it's putting pressure on hospitals. Victorian mother of five Amy Woodall said she experienced this firsthand when her fifteen-month-old son had croup in March this year. This is not the first or last time Mrs Woodall struggled to get her baby seen for respiratory problems. She demanded answers from her doctor. "And I questioned them on it at the time and said when will you start seeing little kids and actually doing your job as a GP? And he got quite defensive

There are rising concerns among parents that children with respiratory illnesses are not being seen by their GPs - see below. There are rising concerns among parents and medical professionals that sick kids aren't getting treated by GPs and it's putting unnecessary pressure on hospitals.

The Royal Australian College of General Practitioners is defending doctors who are refusing to see young children and babies with respiratory symptoms, saying it's because they don't have enough protective equipment.

This is despite rising concern among parents and some other medical professionals that sick kids aren't getting treated by GPs and it's putting pressure on hospitals.

Victorian mother of five Amy Woodall said she experienced this firsthand when her fifteen-month-old son had croup in March this year.

"[The GP] wouldn't see him because he had a cough," she said.

"Being respiratory, and he was only young, I didn't want to chance it, I wanted to get his breathing checked. So, we went to the nearest public hospital and we waited for six hours to be seen."

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(This child is exhibiting signs of respiratory distress and possible epiglottitis. Epiglottitis is always a medical emergency requiring antibiotics and airway support for treatment. Sitting up is the position that facilitates breathing in respiratory disease. The oral pharynx should not be visualized. (Analgesic ear drops can provide topical relief for the intense pain of OM. Decongestants and antihistamines are not recommended in the treatment of OM. Aspirin is contraindicated in young children because of the association with Reye syndrome.) An 18-month-old child is seen in the clinic with otitis media (OM).

An 18-month-old child is seen in the clinic with AOM. Trimethoprim- sulfamethoxazole (Bactrim) is prescribed. Which statement made by the parent indicates a correct understanding of the instructions? a. "I should administer all the prescribed medication." b. "I should continue medication until the ANS: A Eliminating tobacco smoke from the child 's environment is essential for preventing OM and other common childhood illnesses . Nasal decongestants are not useful in preventing OM. Children with uncomplicated OM are not contagious unless they show other upper respiratory tract infection (URI)

Mrs Woodall said the hospital was so full that the consult occurred in the waiting room. She was told to follow-up with the GP.

But even armed with a negative COVID test, Mrs Woodall struggled to get that GP appointment.

"To not be able to easily take them to the doctor, it just adds that extra level of stress to parenting, when it's already quite hard."

This is not the first or last time Mrs Woodall struggled to get her baby seen for respiratory problems. She demanded answers from her doctor.

"And I questioned them on it at the time and said when will you start seeing little kids and actually doing your job as a GP? And he got quite defensive," she said.

AMA confirms reports that children are being turned away by some GPs

The ABC has spoken to and seen social media posts by other parents with similar stories.

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An infant or child with respiratory distress will attempt to keep his or her alveoli expanded at the end of inhalation by An oropharyngeal airway should not be used in children who have ingested a caustic or The EMT should be MOST concerned when a child presents with fever and Greenstick fractures occur in infants and children because: their bones bend more easily than an

Both parents . were asked to complete their questionnaire. jointly at home. The children ’s questionnaires. were self administered in their classrooms, under the supervision of a team of research. workers using a standard set of procedures. For. the diagnosed illnesses , the parents This is in agreement with previous reports on asthma and wheezing symptoms [4, 5, 19] and with observations made in other medical fields indicating that agreement varies with the type of information sought [19±22], and that parent - child agreement is higher for conditions that are common, visible or

The Australian Medical Association (AMA) has also said it's been hearing reports that children with respiratory illnesses aren't being seen by some GPs.

"As a doctor you sign up for something and you must not abandon patients. You do need to consider the needs of the patient," said the AMA's Vice President Dr Chris Moy.

"Having said that you need to balance up the risks to yourself as a doctor and other patients in the waiting room."

He explained that while doctors are faced with this difficult balance, there are ways of managing it.

That includes greater use of personal protective equipment (PPE), managing where patients sit and are assessed, and using telehealth.

Dr Moy said telehealth doesn't always work either and sometimes "you just have to see patients for the safety of the patient."

"There are however limitations in GP clinics in that quite often we don't have the infrastructure like negative ventilation rooms and the PPE that hospitals have," he said.

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Children with uncomplicated OM are not contagious unless they show other symptoms of upper respiratory tract infection. Children should be fed in a semivertical position to prevent OM. It is true that mothers of hospitalized toddlers often experience guilt and that separation from mother is a major developmental threat for toddlers, but the main reason to keep parents at the child 's bedside is to ease anxiety and therefore respiratory effort. An infant with bronchiolitis is hospitalized.

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GPs need clear direction from the government, RACGP says

In March, Queensland's Chief Health Officer Dr Jeannette Young wrote to GPs, asking them to "return to seeing patients face-to-face to the greatest extent possible … even those with respiratory symptoms."

The letter went on to say that presentations to Queensland emergency departments had increased since GPs stopped seeing patients and a third of those visits were for illnesses that could have been treated by a GP.

Also in March, Victorian Liberal Democrats MP David Limbrick raised his concerns in state parliament that children with serious conditions like croup were being left untreated or until they had a negative COVID test result.

But the Royal Australian College of General Practitioners said doctors do want to take the strain off hospitals and see sick children, they just need the right equipment to do so.

"GPs need to have full PPE supplied as the hospitals are, because at the moment we're having to fund that out of our own pockets, which is quite expensive, " said the RACGP President Doctor Karen Price.

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She's renewed calls to the federal government for more investment in resourcing GPs with PPE and also said there needs to be clearer directives from federal and state health authorities about how to balance needs of sick patients with the risks to clinic staff and other vulnerable patients.

"So, we need to understand from our public health leaders what exactly they expect us to do in this situation. We don't want to be involved in something that's against public health advice."

In a statement to the ABC, a spokesperson for the Department of Health said the Commonwealth's supply of PPE is not a mainline supply and GPs should source it through commercial means first.

It also said there's no Commonwealth directive for GPs not to see patients with respiratory symptoms but adds that some practices may choose to do this if they can't ensure the safety of everyone in the practice.

However, some GPs are willing to see patients with COVID symptoms. One of those is Sydney doctor Daria Fielder.

"I think the responsibility remains as always to provide care to unwell patients, whether a child or adult, especially in an emergency," Dr Fielder said.

"I would urge all GPs to see patients who are presenting with respiratory tract infections, in person.

"If you're not seeing them then you would be putting an enormous amount of stress on our emergency departments."

Still, Dr Fielder agreed that there needs to be better guidelines from governing health authorities about how to approach this difficult situation.

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This is interesting!