Background
Methods
Settings
Participants and recruitment
Paticipants code | Gender | Age (years) | Year of training | Educational background | Work experience and Departments | Workplace location |
---|---|---|---|---|---|---|
1 | Male | 24 | 1st | Bachelor of Clinical Medicine | None | Northern China |
2 | Female | 36 | 1st | Graduate of General Practice | 14 years as a GP | Northern China |
3 | Female | 22 | 1st | Bachelor of Clinical Medicine | None | Western China |
4 | Female | 27 | 3rd | Graduate of General Practice | None | Eastern China |
5 | Female | 24 | 1st | Bachelor of Clinical Medicine | None | Western China |
6 | Male | 24 | 1st | Bachelor of Clinical Medicine | None | Western China |
7 | Female | 29 | 3rd | Bachelor of Clinical Medicine | 3 years as a GP | Northern China |
8 | Female | 24 | 1st | Bachelor of Clinical Medicine | None | Western China |
9 | Female | 27 | 1st | Master of General Practice | 1st year as a GP | Eastern China |
10 | Female | 28 | 3rd | Bachelor of General Practice | None | Eastern China |
11 | Female | 27 | 1st | Master of General Practice | 1st year as a GP | Eastern China |
12 | Male | 24 | 1st | Bachelor of Clinical Medicine | None | Western China |
Interview and data collection
Data analysis
Results
Categories | Factors |
---|---|
1. Changes of GPs’ work content in COVID-19 | Different responsibility of GPs in COVID-19 |
New roles of GPs in COVID-19 | |
Increasing use of telemedicine | |
2. Challenges of being a GP | Exhaustion due to medical workloads |
Low income | |
Lack of resources in primary medical institutions | |
Distrust of GPs in society | |
3. Psychological changes of the career | Feeling unsafe on the job |
Inspiration by role models | |
Motivation by medical colleagues | |
4. How to provide better primary care | Strengthening public health education |
Improving medical skills | |
Self-protection in preventing infectious diseases | |
Construction of family doctor team and better co-operation |
Changes of GPs’ work content in COVID-19
“Some GPs worked around the clock with security staff at the checkpoints, where they recorded epidemiological history and conduct health checks for travelers. For residents in the community, health education was delivered and body temperature was recorded daily, which relied on the door-to-door visit of GPs, especially in rural areas.” (Participant 10)
“We also monitored the condition of patients with chronic diseases and instructed them about medication.” (Participant 2)
“GPs made contributions in identifying suspected cases, controlling the source of infection, and cutting off the route of transmission. They were seen as the health care “gatekeeper”. Their work is ordinary but crucial.” (Participant 11)
“The specialists are committed to reducing the number of critically ill patients and deaths, while GPs are aiming at reducing the number of infected patients and protecting the health of the whole people, which relieves the burdens of the most front-line specialists.” (Participant 4)
“Communication tools such as WeChat and some APPs for online medical care came into use in medical practice. Patients could make appointments and communicate with GPs online, then they were offered guidance on health care and psychological support, and purchased drugs online under the instructions of doctors, which may be a new way of work for GPs.” (Participant 9)
“Telemedicine provided a tracking system for infected patients and their contacts, which was convenient for disease control in community. For medical education, teaching was also shifted to digital solutions. (Participant 1)
Challenges of being a GP
“Door-to-door visits for follow-up and health education were required every day, so the workload suddenly increased. The most prominent feeling of our colleagues was ‘very, very tired’.” (Participant 7)
“The subsidies during the epidemic was only 1 / 12 of that for the same hours of other volunteers. It’s not a matter of money. I just don't think our efforts were appreciated.” (Participant 10)
“The available categories of medications for chronic diseases are only a few, and computed tomography (CT) has not been popularized in primary medical units, so we can do limited things when making the diagnosis and treatment of COVID-19.” (Participant 4)
“In their opinions (including the managers), GPs can only treat minor ailments and are incompetent when it comes to complicated disease conditions. We do more managerial work than practicing medicine, thus we have little opportunities to get improved.” (Participant 10)
Psychological changes of the career
“It is impossible to see without fear that medical staff got infected. If I can't even protect my life, what is the point of work? My parents will be more worried and they don't want me to work in the most affected areas.” (Participant 8)
“Doctors are at high risks of occupational exposure in Wuhan, but some patients deliberately tore off the doctor's mask, which makes me feel disappointed.” (Participant 11)
“Professor Zhong Nanshan is the famous expert in respiratory diseases. He alerted the human-to-human transmission of the unknown virus for the first time; Professor Wang Chen (President of PUMC) is one of the people who proposed to establish mobile cabin hospital for hierarchical diagnosis and treatment of COVID-19. They are the role models of doctors, and I want to be like him someday.” (Participant 6)
“Doctors in China responded to the call without hesitation, regardless of payment or sacrifice. They are really respectable. I am eager to go to the frontline to support if I were qualified, driven by a sense of responsibility.” (Participant 9)
How to provide better primary care
“At the early stage of the epidemic, some people refused to follow the inspection rule and take a quarantine, or didn’t wear masks in a proper way, which reflected the lack of public health education on communicable diseases.” (Participant 1)
“Poor personal hygiene is not rare in rural areas. We can't wait until another epidemic to take actions. Instead, health education is necessary to keep protecting the public.” (Participant 5)
“COVID-19 is a disease with several systems and organs involved. Patients are needed to be taken care of as a whole with the help of multidiscipline cooperation, and that’s what GPs are good at. Thus, comprehensive improvement of medical skills in diagnosis and treatment of diseases are needed.” (Participant 2)
“We studied knowledge of epidemics and skills for self-protection in work, such as regulations of working in the isolation area during the epidemic, and how to put on and take off the protective suit. These trainings should be a necessary part of future GP education.” (Participant 12)
“I am more aware of the importance of self-protection. Moreover, when we engage patients, medical history taking should be attached more importance to.” (Participant 3)
“GPs are requested to cooperate with public health workers, community workers, volunteers, drivers, etc. to take actions in the control of infectious diseases. The cooperation is of vital importance for the anti-epidemic work being carried out smoothly in community.” (Participant 10)
“At present, the family doctor team is mainly composed of two to three people, including community workers, nurses and family doctors. However, if psychologists and pharmacists could be recruited, the team structure will be more reasonable, and team members will provide health care in different aspects.” (Participant 1)