"Indirect consequences of restricted services"

Indirect consequences of restricted services and lack of face to face consultations

A client I am currently working with has given consent for their story to be shared from a professional perspective. They have also been encouraged to share their own thoughts and feelings about their story.

As an experienced parent, my client sought appropriate advice and guidance from health professionals in relation to her baby's eczema and poor skin condition. Due to the current circumstances of a National pandemic, his health needs were managed by telephone reviews in the primary care setting. Despite different prescriptions for topical treatments and hydrocortisone creams, the baby's skin did not improve and after several months of no improvement, parents were becoming frustrated at the lack of progress. Furthermore, parents were confused as to why his eczema was as bad considering they were following instructions provided for the topical treatments.

I became involved with this baby's care after his parents had sought a private consultation from a local source in order to exclude the possibility of allergies. From his nappy, parents were advised their baby had a Cow's Milk Protein Allergy and was Lactose intolerant; therefore, parents requested an appropriate referral to dietetic services and he was transitioned across to the appropriate formula milks. Parents removed all dairy products from their baby's diet and continued to liaise with the primary care team who were managing his exacerbation of eczema. At this stage, parents had been trying to manage their baby's eczema for approximately six months without any improvement.

Again, over the following weeks, the baby's skin did not improve and parents advised his eczema was top to toe all over his body; therefore, I was able to liaise with his GP and parents were encouraged to seek a face to face review to ensure this baby received an appropriate assessment of his skin. Parents were now sceptical to the allergy diagnosis they had received from the private consultant and remained confused. 

It transpired from a physical assessment that his eczema was infected and was therefore prescribed a course of antibiotics, which has been successful and his skin has improved significantly. His parents are now able to manage his skin effectively with daily emollients. Due to their sceptism and experience as parents, cow's milk and dairy products were also re-introduced with no ill effects to the baby. He is now a happy, contented baby and parents are relieved they have finally been able to resolve this issue for their baby.

As a health professional myself, I wanted to share this story as it made me feel incredibly sad this young baby may have endured several months of uneccessary pain and discomfort as a result of restrictions implemented during the period of COVID19 and the impact this has had on face to face assessments in the community setting. 

Whilst I fully acknowledge why restrictions have been implemented during a time of a National pandemic, I feel this story highlights the importance of quality assessment and the importance of using our clinical judgement to decide when face to face assessments are required, particularly when facilitated with appropriate PPE.

Whilst the family may have experienced feelings of angst, despair and frustration, I also question what the cost may have been to the wider community and NHS with implications of treatments and prescriptions being inappropriate because of assessments being carried out by telephone.