write a dialogue between you and a doctor on how to keep your life safe from covid-19
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Answer:
The year 2019 has endured a global health crisis in the form of the COVID 19 pandemic [1]. The disease caused by the Severe Acute Respiratory Syndrome Corona Virus 2 (SARS CoV2) spread widely across the globe and infected millions and had a case fatality rate of around 1% [2]. The pandemic entered India in late January 2020 and held fort infecting a large number of people up till late October, when the number of cases started declining [3]. In 2021, the country is facing a second wave of much larger and more catastrophic proportions. Countries responded to the pandemic with the closure of air travel, strict quarantine rules, lockdowns to limit the spread of infection, and mandatory public health measures such as wearing masks in public, temperature monitoring, hand sanitizing practices, and strict isolation and treatment of the infected in dedicated Corona Virus Disease 2019 (COVID 19) care facilities. India imposed one of the harshest lockdowns in the world during the first wave in 2020 [4]. On one hand, the infection was ravaging the population and on the other, the stringent public health measures were hurting people. One of the serious negative impacts of the public health interventions has been restricted access to health facilities and the lack of available treatments for non-COVID 19 illnesses in the public health system. Many routine public health activities suffered because of the high emphasis placed on COVID 19 prevention activities [5].
Doctors and frontline health care providers are at particularly high risk of contracting COVID 19 [6]. Therefore, there were major changes in how front-line healthcare workers delivered their services. Non-emergency surgeries were postponed. Frontline health workers were advised to wear masks and personal protective equipment (PPE) to safeguard themselves from the infection [7]. Physical distance was advised, so the doctor-patient encounters happened from a safe distance of about 1 meter. Doctors also limited the time they spent with the patients to effectively restrict the transmission of the illness. It is highly likely that these changes in the way that doctors delivered their services would have impacted the effectiveness of the doctor-patient interaction.
This study was conducted to assess the difficulties faced by patients attending a tertiary care center in Chennai, in the doctor-patient communication during the peak of the COVID 19 pandemic and to study its influence on the trust in the doctor-patient relationship.
Materials and methods
This study was conducted from July to September 2020, the peak of the COVID 19 pandemic, in Chennai, a metropolitan city in Tamil Nadu, a southern state in India. The study was conducted among persons attending a tertiary care hospital. This hospital serves employees who are covered by the Employees State Insurance Scheme, which is one of the world’s largest social security schemes serving employees who earn an average monthly income of less than INR 25,000 (USD 350) [8]. The nationwide lockdown imposed in India on 24 March 2020 continued in Chennai over several spells.
The sample size was estimated to establish a 50% prevalence of difficulty in doctor-patient communication with a 10% relative precision and 95% confidence level as 384 participants. Non-probabilistic sampling, stratified by the place where the participants were interviewed, namely outpatient department, ward, COVID 19 isolation facility, and hospital waiting area was performed. This was because the patients in these locations represented various levels of severity and illness profile.
A questionnaire was developed by the study team for this research comprising of three major domains namely, difficulties in accessing the health facility, difficulties faced in doctor-patient communication, and trust in the doctors. The questionnaire responses were in a Likert format with options of ‘strongly disagree’, ‘disagree’, ‘neither agree nor disagree’, ‘agree’, and ‘strongly agree’. The questionnaire items were shared with 5 experts in public health, infectious diseases, and nursing, and content was validated. A pilot test was done among a random sample of 10 participants and based on their inputs the wordings of the questionnaires were modified to improve understanding. The questions were developed, content validated, and pilot tested in the Tamil language. The final data collection was also conducted in Tamil. After analysis, the questions were translated to English for presentation.