Issue link: https://viewer.e-digitaledition.com/i/1240593
DIFFICULTIES FOR CLINICIANS The ways in which medical specialties are being affected by the COVID-19 pan- demic caused by the global spread of the novel coronavirus are widely varied. On one end of the spectrum, some special- ists have been a ll but taken out of the picture. With the marked restriction of nonurgent medical services, specialties such as dermatolog y, various surgical specialties, etc., have been restricted to only emergency care, which may create financial stress for these clinicians and their employed staff, and it can make them feel benched when their natural medical instincts would incline them to want to jump in somehow. Other clinicians — such as inpatient specia list s, hospit a list s, ICU cli n i- cians and pulmonary specialists — find themselves drawn into the immediate front line, working long shifts with all that entails, including the direct fear for personal safety and that of their families. In the time of COVID-19, some clini- cians have to determine how to reinvent their practices and adapt for safe practice. Many will be asked to assist outside of their normal scope if demand requires it. In New York, orthopedists are work- ing in the ICU, managing ventilators. Meanwhile, babies will be born, hips will break and heart attacks will occur, and the respective medical teams will have to figure out a way to provide safe care for these non-COVID medica l needs. Even more mind-bending in complex- ity is mapping a plan of care to meet the medical needs that arise in patients who are COVID-19 positive while also needing care for a normal-occurring medical issue, such as a COVID-positive mother in labor or a COVID-positive patient requiring acute surgery. Many healthcare providers, including first responders, physicians and RNs, find themselves socially isolated from their own families, in some situations having to live entirely separately from their families to protect them from COVID-19 exposure risk. I am one of the few primary care doctors in my a rea who still actively admits my patients and follows them in hospital when admitted. At this time, I have sequestered to my office; although, I fully anticipate a time when I will be needed in the hospital on a full-time basis, perhaps within the month. At that point, I will have to live separately from my family. TELEMEDICINE CROSSROADS At my prima r y ca re practice, a s our community developed higher rates of asymptomatic carriers over recent weeks, it became clear that it is impossible to identify this risk and therefore to safe- guard our staff and other patients from exposure. In the past week, we quickly transitioned — within six hours of making a final decision — to a secure patient care model using a telemedicine platform for our patients. We saw ourselves in the counterintuitive dilemma of closing our doors to in-office patients for the first time in 35 years in order to protect them. We are a 14-provider primar y care practice with 40,000 patients in a tri- state area. We realized that if one of our providers or staff members tested positive for COVID-19, the entire office would be closed due to a mandated quarantine, which would result in 40,000 patients being left without access to their primary care providers. We have required all staff to take an oath for extra stringent social isolation/safe practices to minimize put- ting one another at risk for contracting COVID-19. The response of patients, the obvious relief and gratitude when we con- nect with them through telehealth, has been overwhelming. TAKING CARE OF OURSELVES For many reasons beyond the scope of this conversation, medical providers are disproportionately at risk for addiction, stress-related menta l hea lth issues, depression and anxiety. We are condi- tioned to care for others but struggle with self-care. Many of us even feel shame asking for it. Many don't even have a personal physician. BY SIOBHAN A. DUFF, MD, CCFP, ABFP, AMERICAN AND CANADIAN BOARD-CERTIFIED FAMILY PRACTICE PHYSICIAN AND PRACTICING PARTNER AT CHATTANOOGA FAMILY MEDICINE PRACTICE IN CHATTANOOGA, TENNESSEE The Impact of COVID-19 on the Medical Community: The Impact of COVID-19 on the Medical Community: A Family Practice Physician's Perspective 1 2