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Curbside Consult with Dr. Jayne 3/16/20

March 16, 2020 Dr. Jayne 3 Comments

Mr. H recently published a reader comment that asked for more COVID-19 news that isn’t necessarily healthcare IT specific. While he waits for responses to his poll about the issue, I’m going to go with the leading response and share some reports from the field.

The American Medical Association recently published “A physician’s guide to COVID-19” that I will use it as the framework for some comments. Before I begin, please note that the comments below are not necessarily my own. Some have been culled from my personal Facebook feed, text messages, and chats with friends. All are presented anonymously. They are the words or thoughts of the individual physicians, nurses, medics, techs, and frontline folks and in no way reflect the opinions of their employers. Readers, please excuse my digression from the usual, because what we are experiencing right now is anything but usual.

Communicate your COVID-19 updates and details about your preparedness plan with both staff and patients.

  • OMG, the president of our medical group just went on TV and bragged about our testing capabilities at the same time an email went out to the staff that said that we were not telling the public we could test. #cluster
  • TV reporter knew more about hospital plan than MDs did.
  • Admin is more focused on updating the EHR (which they did without telling us, then had to roll it back, then updated again without so much as an email). Makes us feel unstable and vulnerable and we don’t need that right now.

Take measures to keep “Persons Under Investigation” (PUI) and others with suspected COVID-19 symptoms separate from the rest of your patients.

  • We are a walk-in facility and we don’t know whether a person is high risk until they’re at the front desk with the receptionist. They are taken to the first available exam room and the door is marked with a Post-it to let people know they’re high risk. The medical assistant and physician who see the patient put their initials on the Post-it so that no one else inadvertently walks in. Anyone else think this crazy low tech? What if the sticky falls off?
  • Our office canceled all well visits and are seeing sick only. They have to call and be triaged by RN or provider. They wait in their cars and we text them when they can come in.
  • It’s still flu season. Who has symptoms that DON’T look like coronavirus?

The CDC recommends specific measures to minimize the spread of infection that include: proper use of PPE, including eye protection.

  • LOL! We haven’t reliably had masks in clinic since February. Admin seems to think that outpatient departments don’t see sick people. No gowns and no face shields, either. Other hospitals have drive-through testing clinics with nurses in full PPE reaching through car windows. We’re swabbing patients in our street clothes. No showers at work and nowhere to change. Most of us are stripping in our garages before going straight to a hot shower at home. I haven’t seen an N-95 mask since residency.
  • Why do nurses in China have three layers of protective gear but I can’t get a disposable gown?

Misinformation about COVID-19 is being shared across social medial and other platforms at alarming speed. Physicians have a duty to correct dangerous and misleading myths that could harm patients’ health. Read the biggest misconceptions.

  • I continue to encounter people who think this is all media hype or a political tool. Do they really think that millions of people in Italy give a damn if this makes Trump or anyone else look bad?
  • OMG. If I see one more post about “quarantine babies” nine months from now, I want to scream. As an OB/GYN, does anyone remember Zika Virus? We don’t know what this virus will do to a developing fetus. Use protection, people!

I worked today, and it was a rough one. Although patient volumes were (thankfully) down by about one-third, nearly every visit involved an in-depth discussion about risk factors for coronavirus infection. I had to counsel multiple patients that they should not go visit their grandparents or other elders, even if feeling well. Probably half of them seemed to take my advice, the other half plan to do it anyway.

People were still asking if they should take spring break trips, despite footage of the crushes of travelers at O’Hare and DFW airports all over the news. Friends texted from Colorado, miffed that the ski resorts were closed. I mentioned that hospitals there are communicating with physicians that they are past containment in the state, moving to a strategy of mitigation, where only hospitalized patients would be tested. It will just be assumed that symptomatic patients have it and need to be quarantined and managed at home if they are well enough. Patients are upset that elective procedures have been canceled, and apparently Sunday at the urgent care is the place they have chosen to try to get their issues addressed.

We’re still in early days with this pandemic in the US and the stress levels I’m seeing are off the charts. People are using humor to try to get through, but as a veteran of a Level 1 trauma ED, I can tell it’s a mask for some who are really scared. I’m in a lower acuity setting now, but I can’t imagine what this is going to look like over the next 30 days.

Workers in non-healthcare environments are also stressed, including supermarket employees and restaurant workers. Parents don’t know what they’re going to do for childcare when schools close. People living paycheck to paycheck don’t have the means to stock up on supplies. Han Solo would definitely have a bad feeling about this one. I’m sure we’ll all find our new normal, but it’s going to take some time.

I had intended to judge the results of the non-HIMSS shoe and sock contests tonight, but after I came home, worked through my well-planned decontamination routine, and then discovered my hot shower would be hampered by a broken shower head that was akin to standing under a garden hose, I was just done. I have plenty to be grateful for – I’m not working the intensive care unit, I’m not working a big-city trauma service, and at least part of the time I can work from home. I have plenty of non-perishable food and I know how to recognize good leaves and bad leaves in case I need to operate without toilet paper. My sense of humor is still intact, or at least I hope so.

What has changed in your life in a post-COVID world? Leave a comment or email me.

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Currently there are "3 comments" on this Article:

  1. As of last week when I responded to a separate HIStalk poll, it was living as usual. Today, with the exception of needed grocery runs and other absolutely necessary trips, we have implemented voluntary self-isolation within our household. My new normal now consists of a more abundant prayer life, homeschooling two kids, maintaining my own regular work-from-home load, and trying to maintain an optimistic sense of “this too shall pass” while doing everything in my limited power to keep everyone in my house safe and sound. I am grateful for front line healthcare workers who are risking their lives to care for their patients, not to mention the grocery clerks who are also working their own “front lines.” I still can’t believe we were ever worried about whether or not to head to Orlando for HIMSS.

  2. On the practice side, most places have a little door barricade set up. People get a symptom check in the barricade one by one before they get in the waiting room area. People are told to call for instructions before approaching the clinic. On the hospital side, most of the clinical folks I’ve talked to have been told not to talk about internal details with the public.

  3. Pediatricians in my state are feeling abandoned. PPE is scarce to non-existent for them. Exposed patients and patients with other communicable diseases (we are still seeing influenza) continue to place primary care pediatricians at risk and queries to the state DOH for help obtaining PPE fall on deaf ears. Yet, they continue to do the work necessary to care for the health and well being of children. For example, failing to maintain adequate immunization opens the door for future surges of vaccine preventable disease. The first ebola epidemic in Africa was followed by a large measles outbreak because the vaccination rate fell. It will be important to look at the collateral damage that ripples out from this pandemic, and hopefully learn from the experience.







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