Curbside Consult with Dr. Jayne 4/20/20

Lots of conversation in the virtual physician lounge on when we will know when it is safe to start to resume “routine” patient care again.

Most of the employed physicians I know have taken salary cuts, and many of my independent peers are holding any physician payments while they try to cover expenses and staff salaries. Practices are running with a skeleton crew, and I’d estimate about half the practices are offering some kind of telemedicine services. (More telemedicine with primary care or non-procedural based subspecialties, less with those that relied on office or hospital-based procedures for their income.)

I know of a handful of physicians that have totally hung up their white coats. They were either close to retirement and are just “done with it,” so to speak, or their employers offered them some kind of buyout to ease the payroll.

A couple of us have been talking about last week’s New York Times piece on how we can safely move away from lockdown and stay-at-home conditions. We’re starting to see other countries that previously looked like they had a good handle on the pandemic who are starting to re-impose controls based on a resurgence of cases, which is unnerving. My state hasn’t hit its projected peak just yet, and without a robust testing strategy, it’s not even clear when we’ll know that we’re peaking. Too many patients are dying at home or in situations where they haven’t been tested.

The NYT piece quotes milestones laid out in an American Enterprise Institute report, which was authored by a group whose expertise many of us trust. One of the key points for moving forward is that “local hospitals are safely able to treat all patients requiring hospitalization without resorting to crisis standards of care, and the capacity exists in the state to test all people with COVID-19 symptoms, along with state capacity to conduct the active monitoring of all confirmed cases and their contacts.”

We’re a long way from that were I am. Healthcare workers don’t always have N95 masks, and those who do are being asked to wear them in a way that hasn’t been shown to be effective. Some care sites such as urgent cares aren’t offering any kind of decontamination or reprocessing – employees are just expected to rotate whatever masks they have (many of which were obtained from hardware stores or family members) until they disintegrate. Local hospitals are trying to figure out reprocessing, but it’s unclear how much the precious masks can take.

An ICU nurse friend of mine posted on Facebook how thrilled they were to get hand sanitizer from a local distillery. The post was accompanied by a photo of a colleague wearing a woodworking respirator. This is in a premier hospital in an affluent suburb of a major metropolitan area, not a safety-net facility or a place without resources.

It doesn’t feel to those of us on the clinical side like we’re even remotely ready to start talking about implementing societal changes that would place a larger burden on healthcare organizations. I applaud the companies like Battelle that are innovating (their mask reprocessing strategy is pretty cool, and the Pentagon is sinking big money into additional units for deployment across the country) but for goodness sake, healthcare workers are wearing trash bags for protection. Trash bags! In the year 2020, in the United States of America. To be honest, did any of us really see that coming? Did we ever think we’d practice in a situation where that was acceptable?

I’m furloughed from my clinical gig, but I still read the email updates. Their strategy when they run out of barrier gowns is to use cloth patient gowns and launder them since all sites have a washer. Let’s see, they’re cloth, they’re not moisture-proof, and then people are going to be at risk handling them for the laundry process. Sounds like a great plan. I think I’d rather have the trash bag, to be honest. They’ve had to remove the glove dispensers from patient rooms because the gloves were being stolen. It’s surreal.

I know many of our readers work for healthcare organizations and you already know these things. If you haven’t seen them with your own eyes, you’ve probably heard about them on command center calls or during supply chain management huddles or in any number of ways in which your world is being impacted by this pandemic. Healthcare organizations are burning through money without hopes of their coffers being replenished for some time, especially since some of them depend on non-emergent services for up to 80% of their budgets.

Families are in the same situation, burning through any emergency funds they had saved, unsure when they’ll be back to work. People are having to make tough choices, and the answers aren’t as cut and dried as any of us would like them to be.

At least in my area some of the safety nets are back up and running. School-based meal pick-up services had been halted after some worker infections, and one of the major food banks had closed temporarily while they figured out a sustainable strategy for continuing to help people.

One of the local community health centers is opening additional drive-through testing sites. I’m not sure how they got their hands on so many tests, but since their community is being disproportionately impacted by the pandemic, I’m glad they have them. At the same time, they’re working very diligently to try to make sure their patients have needed medications and chronic care services, to make sure they don’t just stay COVID-free, but also protect their health as much as possible.

It seems like a lifetime ago we were debating how much money hospitals were spending on massive EHR projects or whether they would ever see their return on investment. I hope all those organizations are pushing the limits of whatever features and functions they can to make the caregivers’ lives easier. I hope the executives are rolling up their sleeves and helping on the front lines and that they’re supporting the staff who feel uncertain or frankly afraid. It’s going to be a long time before we get to any semblance of “normal” and people need all the support they can get.

With that in mind, and in order to support your stress-baking habits, I offer up the Taste of Home Giant Buckeye Cookie. The inhabitants of Casa Jayne give it a “10 out of 10, would eat it again.” I would strongly recommend the ice cream to go along with. We didn’t have it, and it would have been lovely. Even if your local grocer is out of flour, you can probably score the cake mix it calls for.

What has your favorite stress baking recipe been? Leave a comment or email me.

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