60yo female, for hysteroscopy and D+C for abnormal uterine bleeding.
- Refugee from Democratic Republic of Congo
- Arrived 2019.
- 10yrs prior spent in refugee camp with 6 daughters.
- Difficult consultation. Patient requesting only her daughter act as interpreter. Language barrier difficult, particularly on phone
- Conversion disorder
- Developed right sided full body pain, paraesthesia, and dysphagia (couldn’t swallow saliva) 2/7 after arrival in Australia.
- Extensive medical review – nil organic cause found.
- Management through HIPS.
- Most symptoms now resolved.
- Latent TB diagnosed on screening. No treatment.
- Not COVID vaccinated, currently considering.
Implications of latent TB perioperatively?
- Lack of literature around latent TB
- ID advised:
- Screen for symptoms – weight loss, night sweats, cough, haemoptysis
- If nil symptoms present, no specific precautions needed.
- Should ensure gynae team know that patient has latent TB, as all organs can be affected, seeding can occur, and staff exposure from surgical sites.
Video-consulting in perioperative clinic
- Facilitate improved communication in cases with communication barriers
- May also assist with patients who require visual assessment; concerns about frailty/airway, or if F2F consultation impossible or better to avoid (e.g. moving between zones with different COVID regulations)
- Video is challenging to arrange for all patients as it impacts on efficiency and patient satisfaction as patients must “wait” in a virtual waiting room.
- Audiovisual technology requirements – may be challenging for older patients but family and GP surgeries could help
- Video most beneficial as a targeted resource. May set up a specific clinic session for a group of patients to maximize clinic efficiency at other times.