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Curbside Consult with Dr. Jayne 1/10/22

January 10, 2022 Dr. Jayne 2 Comments

I started my HIMSS22 preparations in earnest today with the booking of my flights. I had looked at them a few weeks ago and then was sidetracked by a multitude of things, and based on the dramatic jump in price, I am glad I went back and got them today. I’ll be coming from an airport that isn’t a major hub, so there are some limitations, but I was surprised to see them jump over $300 in two weeks. Capitalism is alive and well, and who doesn’t love warm weather in March? As usual, I’m flying my favorite no-change-fee airline, so if HIMSS throws us a curve ball, I’ll be covered.

Mr. H pondered this weekend whether hospitals will allow their employees to attend. I would say that’s up in the air and all depends on what happens with new coronavirus variants. My local institution banned international travel at the end of December, but said people could travel domestically if they could be back at work within 24 hours. I questioned whether that was realistic based on the number of cancellations in the airline industry. Now they’ve ratcheted it up to the “don’t plan to go anywhere in the next two weeks” level. Many of my super-subspecialty friends are pretty much isolating except for going to work because there are limited numbers of them at each hospital and they can’t afford to both be sick at the same time. Hospitals are still restricting N95s, which I think is not only ridiculous, but counterproductive.

Our area hospitals are doing daily press conferences where they try to keep people calm and confident, but those on the inside wish they would do a little more to paint a picture of what’s really going on. At one hospital where a friend is an emergency department director, they’ve run out of portable oxygen tanks twice this weekend. When that happens, it’s a mad scramble to rearrange patients and get them connected to a wall unit. It also increases the time that patients have to be boarded in the emergency department because they can’t be transported to the inpatient floors if they’re on oxygen and there are no tanks.

One of them finally came out over the weekend and said they had halted all COVID testing for individuals without symptoms. That means no back-to-school or back-to-work testing and no tests prior to travel. I get it – they have to reserve the tests for patients where the result is going to make a difference in how they are managed – but it has pushed testing to the other facilities in town, which were already drowning. Most of the commercial testing vendors now have a three-day wait for testing, and turnaround times can be three or four days on top of that, which makes things challenging.

The same system had announced that it is freezing non-critical surgical procedures. The other players in town are functionally doing the same thing, but are soft-pedaling it to the public by saying that they are managing patients “on a case-by-case basis.” Everyone is nearly out of monoclonal antibodies and no one can get their hands on the new pill-based therapies, but no one is saying that publicly.

The state has dipped below 15% available intensive care beds, yet a number of people aren’t batting an eye. They’re going about their lives like they did pre-COVID, and any talk of flattening the curve to protect healthcare workers and preserve hospital capacity is met with scorn. I ran across someone today who insisted that there’s not a shortage of nurses due to sickness or being out to care for sick family or children whose schools have closed. They said it is because “all those nurses quit rather than taking that poisonous jab.” As someone who has seen the real stats (1.25% attrition rate for failure to vaccinate), I didn’t even engage in the conversation. It’s not worth it and there will be no changing of hearts or minds with that one.

Two more physician friends resigned this week, although they still have to remain in their respective hellscapes for another 90 days for contractual reasons. Hopefully, we’ll hit the peak soon and then come down the back side of it quickly so they can get some relief. Projections are that numbers will continue to be record-breaking for the next two weeks.

Both of them reached out to me for information about telehealth practice and other ways to use their degrees without caring for patients in person. They’re both great docs and I wish I could leverage their expertise on some of my teams, but unfortunately, they don’t have much non-patient-facing experience. I have plenty of other friends who want to leave their jobs but haven’t yet due to a sense of loyalty or altruism. Some have developed healthy coping strategies, but others not so much, so I’m keeping an eye on those that are in the latter cohort.

If you’ve got friends in the clinical trenches, please be aware that generally they are not OK. Although they may seem to be coping on the surface, I don’t know of anyone who isn’t struggling to some degree. Help how you can, whether it’s having a meal delivered or just leaving a bottle of wine on the porch. Physicians are finding creative ways to pitch in. A group of local subspecialists has been reaching out on physician social media groups offering to care for patients who might normally have been seen in primary care for dermatology, ear / nose / throat, and digestive issues. They’ve also offered parking lot space for drive-through testing, which would be great if people could get supplies. Some of our local primary care practices are running seven days a week due to demand, but others have had to close entirely due to lack of staff. Things are truly all over the place.

We’re only 10 days into the new year and I don’t think it’s going as anyone hoped. Regardless of where you work in the healthcare universe, keep an eye out for those who are struggling and offer a kind word or a sympathetic ear where you can. We’re all in this together and it’s going to continue to be bad for the next several weeks.

Email Dr. Jayne.



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Currently there are "2 comments" on this Article:

  1. That’s rough, Dr Jayne. It’s a good reminder that while we’ve become a bit callous to information, it nonetheless stays very real for those in medicine.
    In healthcare, it’s not only back to business as usual, but grown by 5x. You offer up the reality of what’s its “still” like for those in medicine.

    I have to wonder – do you think this will effect the young people who enter medical/nursing schools…? I hope not…. we need smarty pants like you in the profession!

    Thank you for your work. And for reporting it over this loudspeaker.

    B.

    • Believe it or not, med school applications are close to an all-time high (if not actually there). I am amazed by the number of people willing to “Embrace the Suck.” Time will tell though if those people actually go to residency and become practicing physicians, or whether they are doing what I see more and more of every day as physicians fail to complete their training and decide they’re going to be entrepreneurs who can save the world. Some days when I hear that, it’s a little too Elizabeth Holmes for my taste.

      -J







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