Curbside Consult with Dr. Jayne 3/15/21

For math fans, this weekend included Pi Day (3.14), but for me, it also included my one-year COVIDversary. Exactly 12 months ago, I cared for my first COVID-19 patient, who happened to be part of the first cluster of patients in my city.

I remember finding out two days later that the patient was positive, and then seeing on the news that she was part of the cluster and had been admitted to the hospital. Along with the physician assistant who also saw her, I spent the next two weeks checking my temperature and wondering if we were going to get it and if we were going to die. In talking to my med school friends who also work on the emergency and urgent care front lines, we all made promises to see each other “on the other side” not knowing what was next.

There are over two million people dead across the globe, and that includes several thousand US healthcare workers. It’s truly stunning to think about the road we’ve been down with our hospitals and healthcare employers and how we are still struggling with protecting these valuable resources. Many organizations are still managing N-95 respirators under extended-use protocols or even crisis standards of care. The majority of my healthcare worker friends have given up on N-95s because they’re so difficult to get even in the hospital, being saved for “known COVID-19” patients even though we know at this point in the game that a tremendous number of patients can be symptom-free. Many healthcare workers are vaccinated, which gives us some degree of relief that we’re protected. No vaccine can be 100% effective, though, and I have unvaccinated people in my household, so I’m sticking with the N-95.

Although very few people get to see my face these days (other than on a videoconference, that is) ,my skin tells the story of the pandemic, with ongoing creases from extended N-95 use and exponential growth of wrinkles. Maybe my skin would have been more resilient had I been in my 30s, but along with more than 70% of the physicians in the US, I’m part of the over-40 crowd, so I’m sporting the perpetually tired look. One of my residency classmates has an exclusively cosmetic practice and promises she can do wonders with modern pharmaceuticals, but the last thing I want to get into right now is an elective medical adventure.

As I wind down my clinical employment, it continues to be challenging. Our new owners have removed some of the protective policies that we previously had in place. Where they used to cap the number of patients in the building to nine per provider at a time (which was challenging enough), it’s now only limited by the number of exam rooms in the building, which can be 15 to 17 at some locations. That means patients have a secondary wait in the exam room after they’ve already waited in their car or at home, which means they’re often cranky by the time we make it into the room. I’m sure the folly of this change will be apparently when it starts hitting our patient satisfaction scores, but I’ll be gone by the time that lagging data turns up.

The cognitive dissonance involved in an urgent care shift is hard to explain to non-healthcare folks. We’re still seeing acutely ill COVID-19 patients, but are also seeing long-haul patients with ongoing symptoms. I might spend a significant amount of time with a patient who is in a bad way, or who just lost a family member, and then have to walk into the next room to see a patient who just wants testing so they can go on vacation. The majority of the pre-travel testing patients are oblivious to the suffering around them and often tell us how ridiculous it is that they even have to be tested. It’s a lot to tolerate sometimes, and in those situations, I’m grateful that my mask, goggles, and scrub cap obscures my facial expressions.

That’s a big contrast from my consulting work, which is challenging as well as fun, and makes me feel like I’m helping people get better care. I’m working on several projects to address the backlog of cancer screenings that were created by the pandemic. Knowing that my work will have a direct impact on patients makes a difference. Diagnosing cancer is never a good thing, but diagnosing it earlier certainly is, especially when it can be managed more effectively. Patients seem genuinely grateful that we’re reaching out to them to let them know they are overdue for screening and to educate them on current COVID-19 mitigation policies at the health system’s locations. Passing them a link to allow online scheduling has been very effective, and certainly more productive than postcards or mailed reminders.

The highlight of Dr. Jayne’s week was connecting with friends at Medicomp as the inaugural guest for their new podcast, “Tell me where IT hurts,” hosted by Chief Medical Officer Jay Anders, MD. I usually spend some time with their team at HIMSS shooting the breeze and it was good to catch up and talk about the industry, where we’ve been, and where we might be going. I’ would rather have done it in person with a glass of wine, but the conversation was enjoyable all the same.

The highlight of my personal week was some time in the outdoors. Even with some intermittent rain, it was good to be camping again and teaching a bit of outdoor school. I always enjoy time spent with like-minded folks who understand the pleasures of food cooked in cast iron, and the delicacies did not disappoint. The wildlife certainly didn’t care that people were out and about, as we got to experience the sounds of the Circle of Life as a coyote found its dinner. It was less of a highlight for the  members of our party who stumbled on the remains. Still, it’s a reminder that there’s a whole world outside where primal forces still rule, regardless of what we as people try to do to shape it.

For my healthcare worker readers who might be marking their own COVIDversaries, I salute you. It’s been a long year and none of has made it out unimpacted. Here’s to a better 2021 with less time putting out healthcare fires and more time tending campfires.

What’s your favorite cast iron recipe? Leave a comment or email me.

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