Day 257 of #LongCovid and 36th consecutive day without symptoms!

Finger infection has been attended to, but here is a long thread on what it was like to seek medical care during a pandemic #digitalhealth #telemedicine 1/n https://twitter.com/ManeeshJuneja/status/1338799123210899457

So it started with a bit of redness on the side of my finger. Didn’t seem like a big deal, so I used the NHS 111 symptom checker online, answered the questions, it told me it’s safe to look after myself at home 2/n

Over the next few days, the redness seemed to spread further, along with intermittent pain. I really wanted someone to “see” the finger, so went to local pharmacist. They asked questions and said it wasn’t an infection and I should go home and it will resolve on its own 3/n

On Sunday morning, the pain was more intense & the finger was not just red, but swollen – My GP doesn’t offer video calls, I can’t get an appointment on a Sunday & I wanted to avoid visiting a NHS hospital as I didn’t want to spend hours in a waiting room (even with a mask) 4/n

I opted to use the Babylon Health app to “see” a GP from home. Given they don’t partner with my GP surgery, I would have to pay the £49 for a one off video consultation. I filled in a few details, sent a photo of my finger and chose an appointment for 8.10am (3 minutes away!) 5/n

The Babylon app said I could continue using my phone for other things whilst I waited. A pop up appeared whilst I read the news, the Babylon app was informing me the clinician was running a few minutes late 6/n

When the Babylon GP called, audio/video connection was clear. I was able to show my finger up close using the phone’s camera and give them a 360 view of the entire finger. The GP asked me some Qs & I mentioned my Long Covid too & they knew what the problem was 7/n

A bacterial infection of my finger (which can happen to anyone) but they had seen this in other Long Covid patients, in terms of the body not being able to fight off a bacterial infection like a healthy person because the body is still in a state of flux after many months 8/n

The GP prescribed me an antibiotic for the infection (Paronychia), told me it may need drainage at a hospital if it doesn’t improve, and asked me if I had any other questions. I felt reassured having “seen” a doctor and fortunate that I could afford “on demand healthcare” 9/n

After the video call ended, I went into the Babylon app, and added a pharmacy and read the GP's notes. I chose the pharmacy in the Tesco supermarket, <1 mile from my home, the app said the prescription has been sent. The pharmacy wouldn’t open for another 90 minutes 10/n

The GP had also written to soak the finger in warm salty water. So I did that. I arrived at the pharmacy a few minutes after it had opened. The staff spent a few minutes checking on their system and they had not received anything from Babylon, in terms of my prescription 11/n

So I called the Babylon support line, explained the situation & they told me they will send the prescription to the pharmacy’s NHS email address. I waited a couple of minutes, and voila, the prescription from Babylon had now arrived. Medication would be ready in 10 minutes 12/n

When I picked up my medication, I had to pay. The charge for NHS prescriptions is £9.15 for each item. However, this particular antibiotic only cost me £2.94 for 28 tablets, a 1 week supply (it was a private prescription, and some drugs are cheaper privately than on the NHS) 13/n

Fast forward 2 days & despite starting antibiotics and soaking the finger, the pain was worse & the finger was even more swollen, and now it was different colours too! Based upon what the Babylon GP had advised, I went to the Emergency Department of my nearest NHS hospital 14/n

It was 6.45am & 5 other patients in the waiting room when I arrived, I was seen quickly (in terms of someone asking me about my problem) – Went back to waiting room & someone else called me to take blood for testing, about 90 minutes for the results, someone will call you 15/n

As I waited in the waiting room (with a mask on) more patients were arriving, I noticed quite a few were unmasked & some were even coughing near me. I tried to find a seat further away. The chances of re-infection with covid might be slim, but I want to minimise that risk 16/n

So 90 minutes later, a friendly nurse called me back in and explained how drainage of my finger was very much needed, and they would inject local anesthetic (one needle for each side of my finger) before cutting into my skin. Despite that, it was still a bit painful for me 17/n

Interestingly, the nurse explained that with these finger infections, antibiotics can either make the infection worse, or make the infection better. In my case, it seemed to make the infection worse but I should still complete the 7 day course 18/n

The nurse apologised for my blood being taken. There was no need, a mistake which they put down to agency staff. They checked the results anyway (normal) – then they asked me if I had given consent for HIV screening? I didn’t know what they were asking me about! 19/n

The nurse explained that when they take blood, they are now also screen every sample for HIV, but they need patient’s explicit consent for that. They apologised as nobody had asked me for consent, they just took 4 tubes of blood from me! 20/n

So my finger was drained of pus and dressed, and I was sent home, and upon removing the dressing in 3-4 days, to come back if any concerns about the finger remain. They told me that they are here to help and I should never avoid seeking care, even during this pandemic 21/n

I did go back to the ED after a few days, as I wasn’t entirely sure my finger was healing properly. I thought I would have to wait several hours as there quite a few people in the waiting area. I was seen within 5 minutes by a nurse practitioner!! 22/n

The nurse practitioner was kind & inspected/cleaned the finger, said it might take a while to heal & gave me lots of useful tips on after care. I wonder if AI powered services in the future could provide the same “reassurance” that comes with interacting with a human being? 23/n

So in the end I still needed to visit the hospital, but when it comes to telemedicine, it was a fascinating experience to use the Babylon Health app. The convenience of being able to “see” a doctor so quickly on a Sunday morning from my bedroom, and getting a prescription 24/n

I recall having a conversation with my NHS GP a while ago about whether they were going to offer video calls, and their reply was how the audio and video quality of the video calls with patients tended to be poor, hence they stuck with phone calls for remote consultations /end