Check out this 4 minute video clip. What you will see is two female Cardiologists, discussants in my On Doctors’ MindsSM project, talking about the reasons that the pandemic is causing them both major stress. Covering for sick colleagues, concern about lack of PPE, worry about bringing the disease home to their families, being forced to treat hospitalized COVID-19 patients even though they are not trained as Intensivists, etc. are all contributory factors here.
Bottom Line. As I talk with these physicians every month, I wonder… I wonder what impact this stress is having on their current treatment of patients. I wonder whether this stress will cause them to burnout, retire, develop mental health problems, commit suicide.
Again, Wolf Blitzer and Lester Holt have done a wonderful job taking us inside the “nation’s busiest ICU’s” and showing us the living hell that the pandemic has made of the lives of Intensivists. BUT. Office-based Primary Care Physicians and other specialties will also likely be suffering the psychological sequelae of the pandemic for years to come!
What is the worst thing that the pandemic has done to us? Killing 500,000 Americans? Not good! Screwing up major pieces of the U.S .economy? Also, not good!
BUT. Perhaps the worst thing that COVID has done to us is to increase loneliness, and even more pervasively, the fear of being alone.
Check this out. What you will see is the story of a doctor who learns that even though he has asked all of the right medical questions, he has not fully done his job if he has not made sure that he has done as much as possible to treat the patient’s loneliness. To find her missing cell phone and get it to her. To reconnect her with her family.
Bottom Line. Isolation. Quarantining. I talked to a 60-something “bag boy” at my Country Club today. I knew he had had Covid, and I asked him how he had made out with the disease. By way of response, he without hesitation told me that the worst part was being separated from his wife. At home. Quarantining in the bedroom. NOT in an ICU bed. Not on a ventilator. But still being alone.
Hopefully this will be a positive learning experience that comes out of the pandemic. The realization of just how important our connectivity with other people actually is, and how distressing it can be when that connectivity is taken from us!
Check this out. What you will see is a blogging physician asking whether we really mean it when we say we support our “healthcare heroes.”
Here’s the deal. A public health physician ended his day with 10 doses of COVID vaccine left over. What to do? There was at the time no protocol for how to handle left-over doses. There was no known waiting list for him to contact. So, he decided to spend his own time to go search for patients who might benefit from the vaccine before it spoiled. Which he did after getting permission from his boss.
Like the old proverb says, “No good deed goes unpunished.” He was promptly fired from his job for going “above and beyond,” and the District Attorney launched an investigation into whether he should actually be charged with stealing the vaccine. Oh, and the Texas Medical Board weighed in as well.
Bottom Line. Good grief! How many thousands of situations like this have dotted the landscape in the last 4 months since the vaccine became available? Remember the guys who got trapped in a blizzard, and wandered up and down the highway administering vaccine to other trapped drivers before the juice went bad? Did they commit a crime?
Sure, Dr. Gokal got his job back, the Texas Medical Board backed off and the initial criminal charge against him was dismissed. BUT. The DA continues the witch hunt, and the aggravation for the doctor along the way must have been significant to say the least.
SO. Besides the lip service of praising our “front line health care workers,” how about if we actually show them some respect in ways that really matter???
Check this out. What you will see is an exploration of the various jobs that the 21% of physicians for whom the pandemic brought furloughs or other reduction in hours/income have pursued in an effort to keep financially afloat. Dog groomer, warehouse worker, doll house decorator, etc.
Keep in mind that this is the first time in memory that physicians in the U.S. have faced any widespread version of unemployment. Little wonder that 2020 has, as this article reports, led many doctors to consider leaving medicine altogether.
Bottom Line. As we have discussed in previous posts, this is a really strange time to be a physician. While doctors are increasingly valued and some specialties are working unconscionably long hours, others are out of work in whole or in part.
How long will it take the medical community to restabilize itself after this multi-faceted onslaught? I am thinking “Years!”
Check this out. What you will see is a complicated interplay of public perceptions of physicians and the doctors’ own self perceptions. Said what?
Here’s the deal. Prior to the pandemic, Americans were increasingly likely to trust medical advice found on Google and in the social media, and decreasingly likely to trust physicians. Scroll forward. COVID has brought a return of the perception that “the Doctor knows best.” Only problem is, now that they have been placed back on their pedestals, doctors are more than well aware of their limitations in preventing mortality and morbidity caused by the coronavirus. AND. They still have to deal with the administrative claptrap that was burning them out prior to the pandemic. AND. They are wrestling with new factors like telemedicine which were thrust upon them by the pandemic.
Bottom Line. It’s not an easy time to be a physician. Was it ever?
Who would have thunk it??? Check this out. What you will see is a family physician who has made a business out of helping physicians free themselves up from the heartbreak of charting “backlog.” Doctor after doctor with whom I have spoken, especially in recent years, has reported having problems in this area. One physician comes to mind who had been up at 4:30 AM the Friday of our conversation, busily pounding away at patient charting. He reported that he would be similarly occupied that night, and well into Saturday morning.
Bottom Line. The major point of this “Charting Coach” is that backlogs are better avoided than dealt with ex post facto. For example, charting after each patient visit is much more efficient, and more psychologically healthy, than doing all of the charts at the end of the clinical day.
Words to live by in our own careers! “I can always do it later” is typically not a good thing to be saying to yourself!!!
Check this out. What you will see is a fascinating little piece by our old friend “The Country Doctor,” pictured here. In it, he explains the three functions that a PCP serves. Sick Care, Chronic Disease Management and Disease Prevention and Screening are all inherently parts of being a Family Physician.” Goes without saying. BUT. The real point of this piece is that the emphasis that is placed on each of these areas of practice requires some careful thought and is really situation specific.
For example. “Sick Care” is what immediately comes to mind when most people think about primary care. The rapid proliferation of Doc-In-A-Box facilities and telemedicine, both of which are focused on immediate care for the sick, are supportive of this perception. Sick Care is sort of all they do.
On the other hand, at Hilton Head Island’s Volunteers In Medicine, where I am proud to be on the Board of Directors, we emphasize the other two functions. Given that the majority of our 10,000 patients are underserved minorities, we feel that we can do the most good by helping them to manage conditions like hypertension and diabetes, and by making sure that they get screening procedures like mammography done according to guidelines. Sure, we treat the sniffles too, but that is a secondary function.
In most private Primary Care practices, as the good doctor points out, there is a real issue of the availability of time to perform all of these functions, so prioritization becomes extremely important. For example, Disease Prevention, if left to its own devices, can be very time consuming. Because of its “routine” nature, this post suggests that an MD degree is not required to perform this function. Support personnel and media like emails and letters can meet this need very adequately.
Bottom Line. SO. Again, the optimal emphasis of primary care really comes down to “setting.” As usual, reading Dr. Duvefelt’s piece got me to thinking. What is the primary value of being a member of a “concierge” practice, such as the one of which I am fortunate to be a member? Is it more the ability to get a same day appointment if you are sick, or to have a doctor with time available to service you in all of these three areas? I am thinking the latter.
The title of this post is correct. We should in no way confuse the three functions of primary care. Rather, we should consider each of them and decide, for a particular practice setting, which should be emphasized.
In our previous post, we talked about the importance of eliminating “implicit bias” in healthcare through more culturally sensitive training for healthcare practitioners. Today’s post is just a quick addition to the thought. Check this out. A simple idea here. That is, in eliminating implicit bias, based on race, sex, etc., it is essential to have in place role models that are diverse. When we say the word “Doctor,” we want the listener to be as likely to picture a person of color or a woman as they are to flash on a nice, white “Marcus Welby, MD.”
Bottom Line. As was noted in the previous post, there is still a paucity of racial minorities in the physician ranks. Therefore, is essential to get these practitioners out and visible to the community, as role models, as an important part of our efforts to eliminate implicit bias.
Check this out. What you will see is a really important piece on implicit racial bias within healthcare. Why did I underline “within” twice? Simple. Because it is the most important point made here. That is, while it is generally assumed that any racial biases shown in healthcare are the results of general biases coming from society at large, it turns out that the medical community has its own, special, forms of disparity. They are found in the lack of persons of color in the healthcare media, the extremely small representation of minorities in academic medicine, and so forth. In fact, the point is made that disparities in healthcare delivery actually spill over, making racial inequality there even worse.
Set forth here are practical steps that can be taken to correct this egregious situation. Steps like having broad based “bias training” for healthcare students. Having translators and translations readily available. And appointing a “chief equity officer” to pull this initiative all together within an institution.
Bottom Line. A few days ago, I wrote about the excellent program being mounted by Johnson and Johnson, i.e., their $100 Million, 5-year commitment to “Race to Health Equity.” Today’s piece puts a new spin on this mission. It’s not just about getting more healthcare to the disadvantaged. It’s also about making sure that the practitioners are not dispensing bias with their medicines.
Check this out. Download these survey results from Skipta and think about them. Huge survey sample here, with important results available for free. Why wouldn’t you give this a spin?
What you will see are important findings. Very interesting when I compare them with the results of the 10 personal conversations I am having with physicians each month in my On Doctors’ MindsSM project. (NOTE: I am doing this project pro bono. No charge to clients. Want a copy of the monthly findings, including curated video tapes of my conversations with the doctors? Send “I want in” to email@example.com. She will sign you up).
The biggest deal that Skipta sees HCP’s focusing on in wrestling with the future is adapting to the “new normal.” Responding to the changes which the pandemic keeps throwing at them. Yup. In my conversations with doctors every month, I am hearing them talk about the “dynamic” situation. Changes coming at them fast and furious, and in fundamental areas that they never thought would change. Who would think that patient visits would just suddenly disappear in March and April of 2020? Or just as quickly return in early Summer?
And relatedly, finances. Skipta found that to be a hot topic. I am finding the same thing. Practices applying for PPP, furloughing staff, taking 15% cuts in annual revenue, learning to operate with leaner staff and finding it to be very doable and therefore permanent. Again, who would have thought that the finances of medical practice would fundamentally change overnight?
The third big area that Skipta and I have both found to be important as doctors look to the future is patient “engagement.” How to keep patients tapped into the diagnostic and treatment processes when you are interacting with them on Zoom. I talked to two Rheumatologists on Friday that reported exactly the same thing. A lot of the substance of their specialty hinges (Sorry, pun intended) on being able to lay hands on a patient’s joints. No can do on Zoom. Patients also report that they are missing the social aspect of going to the doctor when they are relegated to Telemedicine.
Bottom Line. Use huge surveys or informal conversations as your basis for predicting the future, and you will find the same thing. HCP’s underlying values remain the same, but lots of logistics are changing to constitute the new normal.
The safest way to predict the future? Survey research to learn the numbers and in-depth conversations to learn the backstory.