The pandemic has seriously overloaded the primary health care system. Family doctors had to make decisions in conditions of complete uncertainty, lack of resources, and daily changes in recommendations. As a family physician specialising in both family medicine and infectious diseases, Natia Tkeshelashvili was at the forefront of the response to the pandemic. She was responsible for patient assessment and care through both remote consultations and coordination of in-person treatment.
Adapting Clinical Judgment Under Rapidly Changing Conditions
In the early months of the pandemic, clinical guidelines for treating COVID-19 changed at an unprecedented rate. According to the World Health Organization, in 2020 alone, temporary clinical guidelines were updated dozens of times as new data became available. For primary care physicians, this meant working in conditions where established algorithms simply did not exist, and clinical decisions had to be made based on incomplete and rapidly outdated information.
In her daily work, Natia often had to make clinical decisions in situations where clear guidance was still emerging. During the early stages of the pandemic, up to 30-40% of clinical decisions in primary care were based on observation and practical experience rather than established protocols. In this context, Natia focused on how symptoms were changing over time, individual risk factors, and the patient’s overall condition when determining further management.
This approach gradually evolved into a consistent decision-making system, which helped to reduce uncertainty in her work. Natia has developed a clear risk assessment logic and patient management tactics in accordance with the results of analytical reviews on the need for structured clinical decision-making in crisis situations, including BMJ materials on clinical decision-making during COVID-19.
Risk Stratification and Patient Prioritization in Daily Practice
In 2020, many patients practically lost their usual access to a doctor. Due to the drastic reduction in personal visits, COVID-19 and other diseases were often detected late. This approach matched the growing understanding that patients with underlying conditions faced a much higher risk of severe COVID-19, as shown in data on underlying medical conditions associated with severe COVID-19.
Many of the hardest decisions were made before a patient’s condition looked critical. In practice, Natia paid close attention to small but persistent changes. These included increasing weakness or breathing that felt different to the patient. Further analysis has shown that delays in expanding medical care are associated with higher rates of complications and hospitalizations, particularly in primary care settings. This is an area explored in a study on the impact of delayed medical care on the outcomes of patients with COVID-19.
Natia’s status as a certified EURACT Level 1 trainer also played a significant role in the clinic’s coordinated work. Even before COVID-19, she trained colleagues, and after the pandemic, she provided them with significant support in developing teleconsultations thanks to her skills.
In an effort to reduce the risk of preventable complications, Natia relied on structured follow-up. The patients were able to recognize when they needed to see her again and which symptoms required attention. This constant contact allowed us to adjust clinical decisions as the situation developed. The importance of such continuity during the pandemic was also highlighted in studies on continuity of care during the COVID-19 pandemic.
Communication, Ethics, and Responsibility in Crisis Medicine
During the pandemic, patients often sought medical attention due to anxiety. In her professional practice, Natia Tkeshelashvili strove for clear and calm communication: she honestly explained what was already known about the disease, discussed risks with the patient, and outlined possible steps.
Ethical dilemmas in the work arose constantly. Natia had to decide over and over again whether it was possible to observe the patient at home or whether it was time to urgently take him to the clinic. The choice was often complicated by a lack of places and resources. She made such decisions based not on strict instructions, but on her medical sense and assessment of possible threats.
The doctor’s responsibility does not end at the end of the appointment. Natia maintained communication with the patients and, in the event of a change in their condition, promptly adjusted their appointments. Her willingness to be in touch helped her to respond quickly, and patients eventually felt constant support and trusted the treatment more. All these efforts were not in vain: Natia was later awarded the Status of Brand Person 2024 for her role in the treatment of COVID.
Enduring Lessons for Primary Care and Healthcare Systems
The pandemic has proven that the sustainability of primary health care depends on doctors’ ability to think clinically and make decisions in an environment of uncertainty. Natia Tkeshelashvili’s work highlights the importance of such decisions, not only in crisis situations, but also for the long-term development of a patient-centred and sustainable healthcare system.
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