14 July 2021

A patient comes into the surgery with two concerns – a lump on his arm and life after 19 July

Some people are very clear that “freedom day” means the end of mask-wearing, but my patient is far from unusual in having doubts.

By Phil Whitaker

The swelling in Michael’s forearm was probably a harmless lump called a lipoma but it didn’t feel entirely typical. I issued provisional reassurance but said I wanted to arrange a scan to be sure. These can be tricky conversations. I didn’t want to create alarm but there was the outside possibility this could be a rare type of cancer. These days, the ready availability of imaging technology means it is relatively easy to eliminate even a small risk.

Much human communication is through facial expression; both of us were masked. I studied Michael’s eyes and there was a perceptible widening when I mentioned the scan, but as we talked he seemed to understand that I was erring on the safe side. I checked his address, gave him a time frame in which he would hear from the hospital, then prepared to draw the consultation to a close.
“What are you going to do,” he asked, his gaze flicking down to my mask, “come 19 July?”

Some people are very clear what “freedom day” will mean – masks will go in the bin and social contact will be joyfully resumed, along with many of the other things that make life meaningful. But Michael is far from unusual in having a sense of doubt. Case numbers continue to rise inexorably, vaccines are imperfect, and a new variant could be disastrous. He was taking the opportunity to poll what a doctor thought it best to do.

The answer would vary depending on whom he spoke to. The seven GPs in our practice reflect pretty much the full range of opinion. One of my double-jabbed colleagues still opens doors with a Clinell wipe interposed between the surface and his skin. Another is the embodiment of scepticism and throughout the pandemic has been posting commentary on social media designed to counter what he sees as Covid hyperbole. Some time ago, when evidence emerged that most transmission was airborne rather than via surfaces, I abandoned the flimsy plastic aprons that contribute mere theatre to our PPE. And I am doubtful that the way face coverings are generally used – repeatedly recycled, frequently positioned ineffectually, and donned and doffed according to arbitrary rules in pubs and restaurants – does much of practical value.

Again and again patients consult me with anxiety or depression, or the stress of relationship difficulties or financial insecurity. Every colleague I speak to remarks on the extraordinarily high numbers of mental health problems – a significant part of the unmanageable workload that is overwhelming the NHS. Closer to home, I have watched my two university-age daughters’ lives being blighted by the pandemic precautions. The same must be true for most parents of school-age children. In the practice, we’ve not had a Covid death since January, but there have been hospitalisations, and we continue to support several patients with ongoing long Covid.

I talked Michael through the impressive impact of the vaccination campaign, how his risk of serious disease and death – and of transmitting infection to others – has been dramatically reduced by the two doses he’s had. I also touched on how nothing we do in life is risk-free. But I was reiterating things he already knew. I thought about referring back to his scan, how we could use that to reduce risk because it was comparatively inexpensive, but if the cost of risk-mitigation becomes too high relative to the problem it’s trying to solve, it ceases to be justifiable. But what he wanted was for me to answer his question.

“I’m going to get back to normal,” I told him. Even as I voiced the words I was conscious of those whose health vulnerability renders such a choice impossible. “We’re still going to be wearing masks in here, but other than that I’ll be getting back to normal.”