HOW IS THE PANDEMIC AFFECTING THE PRACTICE OF SURGERY IN THE

PHILIPPINES? HOW CAN THE MEDICAL COMMUNITY IMPROVE CARE OF

SURGICAL PATIENTS?

Since the COVID – 19 virus emerged and brought us this pandemic, certain protocols and
situations affected the medical setting, one of which is the practice of surgery. There were many
interim guidelines that was released, especially here in the Philippines.

Surgeons, as health professionals, are obligated to care for patients. The bioethical theory
of beneficence emphasizes the need for health professionals to behave in the best interests of
consumers, or for their net benefit. Associated responsibilities include caring for patients,
helping friends, organizations, and community, behaving in the best interests of families or loved
ones, and being reasonably aware about relevant aspects of a disorder like COVID-19.

The obligation to treatment is said to be increased during pandemics because of their

better capacity to respond than non-physicians; the tacit agreement for the dangers that come
with the profession; and the widespread acceptance of a social contract to be of use during
emergencies. Surgeons and other medical professionals, on the other hand, have a right not to
overexpose themselves to infection threats. This is consistent with another bioethical theory,
non-maleficence, which states that negative outcomes should be prevented or diminished. The
same care is given to their families and the society in which they live.

Established ethical codes of ethics understand these restrictions, and they are recognised
as legitimate reasons to deny service. These factors do not, however, prevent health professionals
from continuing to dedicate themselves to helping others, even at great personal risk. However, it
must be understood that the risks are not insurmountable and can be reduced. The third theory,
justice, emphasizes the importance of treating others fairly and respecting their interests. The
above bioethical concepts, when taken together, establish the foundation for the importance of
reciprocity. Institutions, if not culture as a whole, have a duty to pay attention to this value.

With this value in mind, organizations, if not society as a whole, have a responsibility to
ensure the safety and well-being of health workers. To resolve these concerns, the hospitals has,
among other things, ensured the availability of protective equipment, established isolation
mechanisms, modified work shifts, and even provided housing accommodations. In the case of a
contingency, and particularly during a crisis, health workers can be forced to take on duties that
are outside of their experience or preparation. Such assignments should be voluntary and require
informed consent, particularly in high-risk areas. These requirements are in line with the fourth
major bioethical principle.

Many that refuse to provide satisfactory service or commensurate work while being
provided with adequate physical security, reasonable substitutes, and even additional material
incentives can be subject to administrative sanctions. Non-surgical facilities can be expected of
surgeons as well. There are further questions about the ability of the remaining staff to attend to
these cases because personnel may be sent to other posts, become sick, or be quarantine yet,
patients may also need emergent surgical procedures. Surgical residents can continue to conduct
operations, which would not be considered "ghost surgeries," as long as they are capable of
doing so.

Surgical residents can continue to conduct operations, which would not be considered
"ghost surgeries," as long as they are capable of doing so, do so under the direction of the
attending surgeon/s, and receive informed consent for the scheduled procedures. More complex
procedures should be handled by the most professional or qualified surgeon as far as possible.
Also senior team members should be willing to intervene in “call for help” conditions.

Infection risks for health care professionals have been linked to insufficient staff safety
and procedures, as well as exposure during specific patient care periods (e.g., intubation,
interaction with body secretions, etc.). Infection management preparation, on the other hand,
reduced these risks. Surgeons and allied health personnel should be given instruction and
repeated advice on the appropriate measures to avoid infection risks, as well as made to follow
them.

The WHO, as well as the Department of Surgery in the Philippines, provide ready guides
for hospital service organizational and operating plans during a pandemic. In accordance with
administrative guidelines, staff can be screened for COVID-19 on a regular basis. Also staffs
who are suspected or proven to have COVID-19 infections can continue to operate in acute
circumstances with more severe manpower constraints, but only under strict guidelines.

With over 4.5 million cases and over 300,000 deaths worldwide, COVID-19 poses new
problems for the international medical and surgical community; the immense burden it has
placed on units around the world has sadly been followed by an increase in COVID-19 infections
and resulting deaths among medical colleagues. To minimize the risk of infection for both
patients and medical staff, it is important to meet the most recent recommendations for surgical
treatment of patients.

Non-priority sectors, such as postgraduate schooling, were severely impacted during the
Covid19 pandemic. During a pandemic, residents are often expected to perform tasks outside of
their fields of expertise and they are the first responders. In Asia, urology residents employed in
densely populated countries such as Bangladesh and Thailand were reassigned to help Covid19
treatment areas, though this was not always needed, as in Indonesia. Medium-sized countries
used a more selective approach to redeploying their forces.

When sending residents to Covid19 zones, trainee experience was a top priority. Almost
every country announced a reduction in clinical practice. This necessitated a significant amount
of time spent calling patients to reschedule appointments. This was a difficult challenge in some
Asian hospitals where the patient information system was not electronic or was not maintained
on a regular basis.

For too many employees quarantined or under self-imposed self-quarantine, or may have
already contracted the disease, there is a need to transfer workers around surgical facilities to
cover workforce shortages. Appropriate personal protective equipment (PPE) is a must, but it has
proven to be a global challenge due to the variable and unpredictable nature of supply chains and
delivery networks around the world. The surgical staff operating on wards of non-infected
patients should retain a high level of suspicion and follow the social distancing theory. Impact of
the COVID-19 pandemic on surgical services provided to patients and nurses (e.g., collaborating
in smaller groups); Splitting teams by working half-time at home and half-time on site; reducing
the number of people in meetings; virtual participation in multidisciplinary team meetings via
telecommunication) Even if the danger is minimal, ambulatory surgery should be avoided
because it necessitates the use of instruments and protective clothing, as well as the risk of
bilateral disease transmission (patient to provider and vice versa). Concerns have been raised
about the negative consequences and lethal outcomes of contracting COVID-19 following
ambulatory and elective surgery. Outpatient clinics should be limited to a bare minimum, and
new forms of care, such as online consultations, should be retained.

These have long been used in rural areas to avoid long travel times, but they can also be
quickly introduced in major urban areas to preserve social isolation during a pandemic. There is
currently no information available to determine the effect on the surgical staff (and associated
healthcare personnel). Several health-care providers in Italy have acquired extreme COVID-19
and died as a result. The overall effect on the healthcare workforce is too early to estimate. A
major global problem is the widespread shortage of personal protective equipment (PPE), which
is expected to have a significant effect on the morbidity and mortality of healthcare workers
infected with COVID-19 due to a lack of adequate protection.

Surgical treatment that isn't absolutely necessary or time-sensitive can be postponed until
the pandemic has passed. Particularly in the middle of a pandemic, however, such procedures
must be carried out, such as appropriate chemotherapy therapy, emergency surgery, and
immediate transplantation, since they are considered life-saving procedures of curative potential.
Total disregard for such surgical facilities can be considered unintended collateral damage,
increasing the number of deaths and life-years suffered as a result of the COVID-19 pandemic.

There is currently little information on the influence of this lack of surgical capability on
patients' surgical conditions and related wellbeing, as well as on their well-being, functional
capacity, risk of loss of function, or adverse prognosis. Patients may experience sadness,
dissatisfaction, resentment, annoyance, and tension as a result of cancellations under normal
circumstances. This is in addition to the possible economic consequences (loss of employment,
sick leave, or failure to sustain occupancy) and family life effects.

There is actually no reliable evidence available to model the number of activities that
have been halted and how this backlog will be resolved after the pandemic. However, rough
figures indicate that about 330 million procedures are performed globally each year, with the
vast majority of high-income countries still following a strict strategy of canceling all non-
essential surgery. With a global estimate of around six million operations per week, the number
of patients that will be affected in the coming months is expected to increase at an alarming rate.
There is no information available about the timetable or length of these cancellations, or what
conditions should be used to restore these programs.

Patients may choose to postpone non-essential elective surgery because they are afraid of
developing the disease while in the hospital during the latest pandemic. This anxiety, on the
other hand, could cause patients to postpone seeking treatment for symptoms that may have been
treatable or curable if they had presented at an earlier stage; loss of function and shortened life
expectancy may be the result of delayed presentation and diagnosis. With the length and
magnitude of the pandemic, this strain can only grow.

In order to improve the patient care for the surgical patients, first and foremost, being at
home should be well practiced in order to avoid center infections and contact with COVID – 19
infection. Beyond professional competence, careful listening, empathic engagement, and not
being hurried are all important factors in building confidence in a care provider. There are well-
established approaches to use, and we know that improving communication skills benefits
patients. With video and audio now accounting for a significant portion of visits, and in-person
care still complicated by the physical barrier of personal protective equipment, it's critical to
incorporate emerging best practices for creating presence, such as paying more attention to vocal
tone and tempo, facial expressions and body language, reflection, mindful practice, and extra
effort to check for understanding.

It's also crucial to find a well-lit, distraction-free environment in which to perform virtual
visits. Rather than adding to our administration's workload, clinician-leaders have started a series
of weekly webinars focusing on telehealth best practices, which are delivered by clinicians for
our fellow clinicians. These webinars provide updates on reporting standards and infrastructure
use, as well as advice on how to adjust contextual communication abilities to remote treatment
and current in-office constraints.

The collaboration mechanism can provide support for patients who are new to interactive
technologies. We've developed a three-stage strategy to ensure a seamless transition: patient
portal electronic messaging with guidance for installing and using our telehealth program, a
second examination by the team who plan telehealth appointments, and finally a dry run by the
physician assistant scheduling the patient for a simulated exam room session. In the face of the
uncertainty we can share with our patients, clinician and staff contact must provide comfort,
attentiveness, and reassurance, particularly when we welcome them back into our office room.
Local clinical administrators should emphasize this point with regular check-ins and
demonstrations. As a fast guide for providers and employees, a "pocket notice" is also being
made.

Continuity of treatment poses several new problems as well. Many patients may be
hesitant to leave their homes as we restore in-office treatment. We've allayed their concerns by
specifically explaining workplace hygiene and distancing precautions, while continuing to
include non-office related treatment solutions. Social distancing recommendations limit office
capacity, highlighting the ongoing need for virtual visits. Patients and clinicians should choose
the solution that best suits their interests by assessing risk and participating in joint decision
making.

Patients should be aware of what to expect if and when they return to the office, from
parking to leaving the building. The whole staff must be concentrated on the successful
distribution of treatment, and simple, straightforward language must be used to communicate
this. Clear reminders in a variety of formats (direct voice calls, text, website, posters, floor
markers for distancing guidelines, directional signs, and protective scripting for front desk staff
and greeters) have been distributed and are likely to reassure returning patients. Caring for
patients with acute febrile respiratory disease in the workplace poses a significant safety risk,
necessitating the creation of a special area of the office dedicated solely to these patients.

In order to decide which staff and physicians are able to take on the heightened personal
risk of caring for the acutely sick, practice leaders are asked to talk candidly and supportively. If
a practice's capabilities do not allow for this, appropriate contingency arrangements must be in
place to meet emergency care demands, such as virtual care, urgent care, or other specified
locations. Digital treatment and remote staffing have necessitated workflow changes. As we
return to some office-based care, we'll need to come up with new ways to switch between
simulated and in-person workflows so that adequate post-visit follow-up care can be coordinated.
 A main experience engine, which has been complicated by the pandemic, is prompt
response to patients' phone and online-portal requests. Along with expediency, a renewed sense
of understanding would be needed to deal with messages that might be more fearful and anxious
than normal. As the Covid-19 attack continues, more of our patients will succumb to the illness
or struggle to cope with the loss of a loved one. Care teams are often called upon to provide
assistance to mourning families, but not on the scale that we have recently seen. Practices are
developing plans to commemorate people who have died or are in mourning, such as civic
memorial boards.

A compassionate and well-cared-for staff contributes to a positive patient experience.

Compassion and cooperation from coworkers are critical in this regard. Huddles have proved to
be an effective team-building tool and can still be used in the virtual world. Meeting pandemic
challenges necessitates an all-hands-on-deck approach, with leaders delivering guidance,
empowerment, and example. Clinicians and support personnel will continue to be emotionally
affected by the pandemic. We ought to build on the gains gained in tackling burnout prior to the
pandemic. Wellness services, ranging from community counseling to individual or collective
psychotherapy, must be widely accessible to support all health care professionals, especially as
we emerge from what has been a truly life-changing period for many.

The Covid-19 pandemic is far from over, but we've hit a tipping point when certain
aspects of in-person health treatment are resumed. As we wait for new methods to assess patient
satisfaction in the post-pandemic period, we can focus on well-established evidence to confirm
what we really know about what matters most to our patients. As we creatively adapt and
reinvigorate our best practices for healthy and caring practice, this is an excellent time to rethink
key elements of a better patient experience.

Ensure that these patients feel comfortable upon returning to their medical practice office
is one of the keys to restoring patient visit volumes and preventing delayed treatment. Medical
practices must earn the confidence of their customers, and this benchmarking data will help them
make the required changes to stay competitive in this ever-changing industry. In addition to
implementing cleaning protocols and other patient protection interventions, healthcare
institutions can need a range of organizational improvements that will make complying with
social distancing guidelines simpler.
 Allowing both patients and caregivers to maintain sufficient space from one another
would be critical to maintaining patients secure — and helping them feel safe. This will
necessitate healthcare institutions keeping clinic numbers down at any given time, necessitating
longer operating hours. Most clinician offices were open for approximately nine hours per day
during the working week prior to the pandemic. Organizations may consider extending their
operating hours during the day or adding weekend hours. This will allow businesses to spread
out patient appointments, stagger employees, and maintain more flexible schedules.

Organizations may want to monitor appointment availability in addition to reducing the

wait time patients face as they arrive at the office. To put it another way, businesses must
evaluate the time it takes from requesting an appointment to finally having it scheduled. To be
fair, both hospitals strive to schedule patients when they are genuinely in need, and this was the
case prior to the pandemic. COVID-19, on the other hand, has made the process much more
difficult, especially during the reopening process. Because of the infection, certain hospital visits
may be more urgent, such as those for people who are experiencing symptoms. Meanwhile, the
reopening process can cause bottlenecks in organizations. Organizations should start using a wait
list by monitoring the time it takes for patients to have an appointment from the time they order it
to when it finally happens. Depending on the discipline, practices will want to think about the
most pressing challenges and which patients may be at risk of negative consequences as a result
of the COVID-19 shutdowns in recent months. At the end of the day, getting patients out of the
office as possible is one of the safest ways to manage clinic volume and keep them healthy.
Telehealth technologies and other resources, such as the patient interface, will help with this.
Patients and caregivers can feel distracted by the speed of transition as news and federal
intervention in response to COVID-19 emerge. Your practice's patient platform is one method
for bridging the void created by stay-at-home orders. Prescription refill orders, reliable instant
messaging, and viewing lab reports are the most common uses of the portal.

COVID-19 can be further diagnosed by proactive evaluation and remote treatment

services for elderly people living at home, which will help distribute money for care and
prescriptions. Symptoms of COVID-19, as well as nonspecific symptoms and signals that may
lead to a new infection of an elderly person such as delirium, behavioural abnormalities, slips,
and improvements in physical status could be monitored on a regular basis by General
Practitioners and family Nurses. The presence of caregivers, as well as their need for additional
assistance, should be assessed on a regular basis, particularly if they are caring for demented or
disabled people. This may also aid in the detection of burnout in both formal and casual
caregivers. Burnout in caregivers is a recognized risk factor for negative outcomes and can
worsen the patient's well-being. To sustain their emotional well-being, older people living alone
at home, especially those with chronic illnesses need surveillance to ensure adherence to
pharmacological therapies, as well as access to healthy food, social and mental health care, and
awareness. Specific phone-based questionnaires have recently been introduced to classify and
track symptoms, diagnose living environments, and assess the effect of social distancing laws. In
the elderly, social alienation and depression have long-term detrimental health consequences.
The current pandemic has amplified these issues in older adults by increasing social alienation
and insecurity for those who live alone or are vulnerable, even affecting the well-being of older
adults who had previously active and stable social lives. The detection of elderly people who are
at risk, as well as the implementation of specific strategies, can help to mitigate the effects of
long-term social isolation. Health and nursing care must be given at home as soon as COVID-19
is suspected. A swab examination, pharmacological treatment, and, if necessary, oxygen therapy
should all be included. The ultimate goal of this strategy is to keep people out of the hospital as
far as possible. It is important to ensure the quality of medical and nursing care as well as the
supply of medications and devices by providing medical and nursing care at home. GPs and all
healthcare providers must be able to collaborate safely and exchange structured evaluation and
clinical treatment procedures for COVID-19 patients. The clinical course of the condition, as
well as the potential adverse effects of drugs, should be monitored on a daily basis. Family
members should be taught how to keep themselves safe from infection.

WHO reminds policymakers that they have a legal and moral duty to ensure the health,
protection, and well-being of health workers on World Patient Safety Day. Both Member States
and related stakeholders are urged by the Organization's health worker charter to take steps to
establish synergies between health worker and patient protection policies and strategies: Make
connections between programs for occupational health and safety, patient safety, quality
improvement, and infection prevention and control. Incorporate health and safety expertise in
personal and patient safety through all stages of health worker preparation and training. Health
care licensing and accreditation guidelines should provide provisions for health worker and
patient protection. Integrate emergency reporting and learning processes for both personnel and
patient care. Integrate patient protection, health worker safety, and quality of care measures into
a single set of metrics, and integrate into a health information system. Develop and introduce
national health and safety programs for health care workers: Develop and enforce national
occupational health and safety programs for health professionals in accordance with national
policy.

More so, what the Philippine government must do is to strengthen first its healthcare
system. Proved assurance and safety will our healthcare workers especially our doctors when it
comes to the COVID – 19 infections, in this way they will be more inspired and determined to
take care and save people’s lives as they are assured that when they are risking themselves
they’re efforts and sacrifice are not putted into waste. Kudos to all doctors! Kudos to all
Healthcare professionals!