It was early February when I first felt the tides changing. I remember it well. I was having lunch with a friend – another doctor – and the situation in China was bleak. We agreed it was only a matter of time before the novel coronavirus would erupt in the United States. As medical professionals, we knew that contagious diseases don’t just stay in a box, no matter how much ocean stands in between. What we didn’t know at the time was just how dire the situation would become.
Less than two months later, this grim feeling became a harsh reality. As a practicing family physician and a medical director for Amwell, one of the nation’s largest telehealth companies, I wear two hats. In my kitchen in rural Maryland, I was wearing my medical director hat, when telehealth providers in Washington State began calling me to report a worrying influx of patients. In my eight years working for Amwell, I’ve never seen such a sharp spike in visits. This is it, I thought.
Over the next couple of months, my entire world changed. I am licensed to practice medicine in 29 different states — including New York, Massachusetts, and New Jersey — and there were some days where my virtual waiting room had 10 times as many patients as normal. As a physician, you train your entire career for moments like these. You feel like you’re going into battle; you’ve been called down to the front lines to care for the patients you took an oath to protect. You feel ready, yet still highly unprepared for what lies ahead.
What’s more, when you see patients for 12-plus hours every day, and each one of them is expressing some form of panic, it’s hard, even as an experienced physician, to maintain a positive outlook. For providers who are struggling to adjust to seeing patients online or those inundated with patients in brick-and-mortar settings, I managed and continue to cope with the realities of COVID-19.
Slow down. As doctors, we are dedicated to helping as many people as possible, especially during times of crisis. However, we must keep in mind that COVID-19 is a new disease and there is so much we still don’t know about the symptoms and how it spreads. And what we do know indicates that the virus can present very differently in different people. Taking extra time to ask patients questions and truly understand how they feel is important to provide the best care. No matter the health concern, patients appreciate when providers spend time reviewing questions and educating. Patient education is an important part of a provider’s job but it oftentimes gets brushed over in brick and mortar settings. Additionally, if you are new to practicing virtually, the learning curve can be steep. It’s a short one, but it can be difficult to navigate the technology during your first few visits. Slowing down and understanding the nuances of providing excellent care virtually will be important in the long run.
Put yourself in the patient’s shoes. There’s a major behavioral health crisis unfolding as the pandemic continues. In addition to those who had previous issues with anxiety and depression, nearly all the patients I see are experiencing some form of anxiety related to the virus. About 80% of them ask a COVID-related question, whether that’s the genesis of their visit or not. I’m not a psychologist, but there are ways I’ve found I can help make patients feel at ease during their visit. For example, the more you can anticipate a patient’s needs, the better. Understand that some people may be scared to leave the house to pick up a prescription, so talking through options is important. As providers we need to be incredibly human during these times. We need to show empathy and work to connect with patients in new ways to help ease their fears and make them feel comfortable.
Find support where you can. It’s important to have a support system to get through these difficult times. I am lucky that my husband also works in health care and understands the emotional toll practicing medicine can have. During COVID-19 his practice was shut down. Having him home with me allowed me to devote even more time to my patients while taking on additional responsibilities around the house. Not everyone is in this position, so you need to find support where you can. There are online resources for health care workers and networks to join, offering a place to come together and share stories and insights. No matter how much we try to block out the hardships of our job or avoid becoming emotionally overinvested in our work, we cannot underestimate the toll a pandemic like this can take on us.
Have a normal routine. Having a routine is one approach I’ve used to keep myself sane. Making time for meals and exercise is important. Just because you can see patients 24/7 online doesn’t mean you shouldn’t still take important time for yourself. Check in with yourself regularly and be honest about how you feel. If you need a break, take one. These breaks aren’t just for you; we must remember how we feel can come out during visits and impact our interactions with patients.
Calculating risks. While breaks are important, understand you may need to calculate risks differently than your friends and neighbors. As parts of the country begin to reopen and see people starting to act like the virus is no longer a threat, medical professions need to understand that we must sometimes abide by different rules. We have an obligation to our patients to keep ourselves healthy. As virtual care providers, we should feel lucky that we can still work without exposing ourselves to the virus unnecessarily. This is an internal struggle I’ve been dealing with personally. While I’d love to start seeing friends again, I feel a responsibility to be extra careful. It’s all about finding the right balance.
The truth is, this is not an easy time to be in the health care industry. Every time we get through one hurdle, another challenge seems to rear its head. But we must continue to face this pandemic head-on and come together as a medical community to support each other.
Mia Finkelston is a family physician.
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