Curbside Consult with Dr. Jayne 11/2/20

I have to admit that being a blogger is a challenge sometimes. Although often the ideas for my columns come to mind easily after working in the clinical or IT trenches, some days are a struggle.

Today was one of the latter. I sat for a good hour without a solid idea in my head. I think a big piece of today’s writer’s block was the sheer stress I’m facing in the upcoming week. The clinical world has been completely out of control, with a good number of our providers down for the count with COVID or caring for close family members who have COVID.

Leadership is begging us to come in on our days off, which is a hard sell when you’ve barely been away from the clinic after your last shift. You also know that if you go in, you’’ll be crushed. So many patients who need to be seen that they are lined up before staff even arrives at the office. One of my receptionists had to park more than half a mile away, which led to a late clock-in and a fair amount of drama getting the situation remedied. Staff has to park in the lots of neighboring businesses and now has the worry of being towed to add to the stress of the day and concern about potentially becoming infected with COVID.

When you’re running with absurd patient volumes, any glitch in the technology becomes nearly catastrophic. At one of our sites, the Citrix client disappeared from multiple PCs. This led to a storm of calls to the help desk and frantic attempts to gain access to the system, all while the front desk was bringing patients in and filling the exam rooms. Trying to execute downtime procedures when you’re also trying to work with the help desk and get yourself up and running is nearly impossible. Trying to perform data entry from paper at the end of the day after you’ve seen 80 patients is just too much to ask.

Patient expectations are high and patience is low, for certain. We’re seeing over 2,000 patients a day and it’s taxing our radiology systems, with images slow to load. When you’re trying to diagnose COVID from chest x-rays because you don’t have enough rapid test kits, that’s a recipe for frustration.

The increasing hacking events directed at healthcare institutions aren’t reassuring. We’re getting daily reminders to avoid using email on work computers to reduce the risk of phishing. Employees who have been caught charging their phones via USB cables to the PCs have been disciplined. Websites have been locked down to the point where you can’t even access major pharmaceutical company information, which is always fun when you’re trying to find a package insert because you’re looking for the details needed to answer a patient’s questions.

Then there’s the thread of physical altercations. Although I haven’t had any at my worksites when I’ve been present, we did have an incident with an anti-masker patient who was ridiculing staff and other patients. He became physically agitated and had to be escorted out of the office. Businesses in our city are starting to board up in preparation for anticipated civil unrest, which is something we never planned for. Although we haven’t received a clinical bulletin on treating patients who have been exposed to pepper spray or other chemical irritants, you can bet that many of us have read up on it.

At least with my experiences in my own clinical office, I’m well prepared to meet the needs of my healthcare IT clients. Most of them are worried about the same issues, but with the hacking concerns magnified as the clients become larger in size. There are so many staff out of the office (both clinical and from a technology standpoint) that no one wants to implement any new solutions or features because they don’t want to stress already burdened caregivers or run implementation teams ragged. It sounds good to hit the pause button, until you realize that some organizations have received grant money or other awards that have strings attached, such as deadlines.

I spent a good chunk of the weekend re-engineering an implementation plan to make all the training virtual and asynchronous, including recording some of the training videos myself. Fortunately, the client has someone who can do some edits and cleanup. Although I can train with the best of them, my moviemaking skills are nearly nonexistent.

With the numbers coming off the Johns Hopkins COVID website this week, everyone is understandably worried about where the next few weeks will take us. Patients are continuing to travel and resume normal activities, and some are going overboard trying to stock up on experiences in advance of potential lockdowns. Mental health services are at a premium and those patients frequently find themselves in the urgent care setting because their primary physicians aren’t able to see them on a timeline that the patient finds acceptable.

I treat panic attacks and anxiety all the time, but there’s a special kind of anxiety that shifts to the clinician when you’re trying to help a patient cope with the fact that she has to have an outpatient hysterectomy because the hospital has put a freeze on “elective” cases that require an overnight stay. We certainly didn’t train for a world where any of what we’ve been experiencing over the last few months would be OK.

Third parties are feeding off the desperation of providers to do something other than practice medicine face to face. I was approached by a telehealth company that wanted to offer me $10 per visit and touted the ability of their platform to let me see 10-12 patients an hour. That, dear readers, is absurd. And the frightening thing is the number of physicians they’ve already signed up. I’m sure the patients don’t know that physicians are going to try to run on those volumes, or that they’re not going to get the level of care they deserve since they’re paying many multiples of that amount for the service. One colleague was offered $10 an hour to supervise a nurse practitioner. Certainly our licenses are worth more than that, but the employer thought it was more than fair. My colleague took a page from Nancy Reagan and just said no.

Then there’s the elephant in the room, which is, what will happen after Tuesday? Patients are girding for everything from “life as usual, since COVID will be gone” to full-scale civil unrest. I saw a patient last week who had been having chest heaviness that got worse as the day progressed but was better first thing in the morning. The culprit – he was wearing body armor around the house, “preparing.” You should have seen the look on my scribe’s face when I pulled that little detail out of the patient. Toilet tissue is once again flying off the shelves, although I was excited to finally score some bleach at the grocery store.

Whatever happens as a result of the elections in the US on Tuesday, my fondest hope is that people will remain calm, work through their emotions, and not lose their cool. I hope we rise to the occasion, regardless of the outcomes and the personalities involved. We all need a break.

How is your organization preparing for election day chaos? Leave a comment or email me.

Email Dr. Jayne.