In The Midst Of COVID-19, Triage Is A Four-Letter Word

In my career as an outpatient family physician, triage is not something that I commonly do. But now, with the COVID-19 pandemic in full swing, it seems the large percentage of my day is spent in triaging patients. And I have to say, I don’t really care for it. (This is an understatement. I’m trying really hard not to use other four-letter words in describing how I truly feel.)

In my pre-pandemic world as a doctor, I welcomed all comers into my clinic. If you wanted a visit, you could have one. If you needed to come in and talk about your great sadness over the loss of a parent, if you needed me to look at that spot on your foot to find out if it was a wart or a corn or something else, if you needed a wellness visit to make sure you were up to date on all of your cancer screening and preventive care … come on down!

These visits were just as important for me, as the doctor, as they were for the patients. That face to face time, that human connection, is a big part of why I chose to practice medicine. I could give you a hug if you were sad. I could greet you with a firm handshake, and you could tell me your latest blonde joke (I happen to be blonde, and some patients do love to tease). I could joke around with my kids (that’s how I think of your children) and send them off with a high five. I could cuddle that newborn baby for a second and smell that sweet spot on the top of his head. Those are the things that made my day.

But now, I am triaging. The New Oxford American Dictionary defines triage (from the French trier, meaning to “separate out”) as “the process of determining the most important people or things from amongst a large number that requires attention.” Instead of welcoming patients into the clinic, we are now tasked with keeping you out, separating you out. The doctor’s office is rife with opportunity for germ-sharing, and we don’t want to put our patients at undue risk. In the setting of a pandemic, this is necessary. But it certainly makes me unhappy.

Each day, I comb the subsequent days’ schedules to see which appointments can be canceled altogether and which can be transitioned over to a telephone visit or virtual care. I am trying to decide which patients truly need a physical exam, requiring that you come into my office, and which can be managed remotely. I am triaging people calling in with respiratory symptoms. Do they need to be seen and possibly swabbed for SARS-CoV-2? Or are they low risk enough to stay home and wait to see if symptoms worsen to the point that they then need to be evaluated? Who gets a test and who doesn’t?

It is not fun for me. It is not fair to you. But it is the world we are living in right now. I worry about my medical partners, the doctors, and nurses who work in the hospitals. Their type of triage is something I hope never to have to experience. With an inevitable spike in cases of COVID-19, if every citizen of this country (young and old) doesn’t do all they can to practice social distancing and sanitizing, and if our government doesn’t do everything it can to acquire the ventilators that our patients so desperately need, our intensive and critical care units will be quickly overrun. And, as we are seeing in other countries, when ventilators run out, the nasty business of triage begins. Those dedicated physicians and nurses will quickly be charged with deciding who to save and who to let go.

The triage process is wholly undesirable for all of us. We wish we could be with you. We wish we could be holding your hand and easing your suffering. It is hard to replace a physical connection with a virtual one. However, medical care, at this moment, requires it. It is what’s best for all of us. But you can bet, when this is all over, that we will be anxiously awaiting a high five and a hug, and we will welcome you back with open arms.

Gretchen LaSalle is a family physician and author of Let’s Talk Vaccines.

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