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From a Consultant Gastroenterologist to treating COVID-19

Alumnus Anjan Dhar tells us the story of switching from his chosen field to re-train as a COVID-19 Physician, and the lessons he learned in the process.

I have been a Consultant Gastroenterologist for the last 25 years, having trained in India, Oxford and London before my appointment to the County Durham & Darlington NHS Foundation Trust. I am also a Professor of Medicine at Teesside and a NIHR (National Institute for Health Research) Researcher / Principal Investigator for research in luminal gastroenterology and endoscopy. In the last four weeks however, I have had to give up my passion and re-train as a COVID-19 Physician, to be able to join my colleagues in looking after the huge numbers of patients being admitted to our hospitals.

“Very early on, I realised that there was a lot of new knowledge to be incorporated into the clinical practice of assessing COVID-19 patients, and there was a need for an objective assessment proforma for these patients. Together with my colleagues in Respiratory Medicine, we created the first COVID-19 Assessment Proforma at Darlington Memorial Hospital, which has now been adopted in over 30 NHS hospitals across the country. We have also adapted to new ways of ward rounds to minimise staff exposure to the virus, including single-person assessments and observations using the Royal College pf Physicians SPACES model.

“Interacting with ITU (Intensive Care Unit) colleagues, we have developed pathways of care for CPAP (Continuous Positive Airway Pressure) ventilation on the Acute Respiratory Unit, and early ventilation for deteriorating patients in ITU. The Respiratory Emergency Department is now manned by Physicians and I have learnt more about PaO2, SpO2, FiO2, ARDS, oxygen use and chest x-ray in the last four weeks than in my entire medical training.

“I have also created a team of Doctors who are collecting COVID-19 Epidemiological Data for all our admitted patients to determine predictors of adverse outcomes and create a predictive model for patients who need ITU care. The DARlington COVid Epidemiology (DARCOVE) Project will help to understand differences in clinical presentation and outcomes in the North East compared to London. I am amazed by the speed at which National Clinical Trials have been set up and have been privileged to participate in some of the national research drug trials (RECOVERY) during this period.

“I have had to manage my Gastroenterology and Inflammatory Bowel Disease patients through telephone and remote consultations using Digital Technologies such as Skype and Zoom. I educated colleagues and juniors on how to manage this disease, which none of us knew much about a month ago. I’ve learnt that a pandemic changes the way we all work in a hospital, and places great demands on us an individuals, teams and healthcare professionals.

“This experience has been very humbling and educational, and has allowed me to reflect on how major world events can transform the way we live our professional lives.”

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published on: 30 April 2020