In the last six weeks or so, the practice of medicine has been turned topsy-turvy by the COVID pandemic. Those weeks seem like an eternity. We have been so consumed with testing and treatment coronavirus, flattening the curve, and figuring out how to wear a mask without having our glasses fog up, that it’s hard to remember health care before COVID. But let’s try, just for a minute. Let’s try to remember what was happening in the world of medicine before the pandemic turned ERs and ICUs into war zones. Before shortages of PPE and ventilator. Before the president suggested that the ingestion of disinfectants could fight the virus. Before patients with other chronic conditions and acute illnesses, disappeared from clinics and ERs and doctors’ offices. Before of health care workers died providing patient care. Before we started giving free coffee to health care heroes. Try to remember. Health care before COVID. Were you burned out? Were you frustrated and saddened by all the barriers to care: prior authorizations and pre-certifications, outrageous copays, unaffordable medication prices? Was your inbox unmanageable? Were you fed up with administrative tasks and tyrannized by data entry? Just overbooked and overworked, unable to meet all the demands of clinical practice during your workday? I had already walked away from primary care before COVID. I’d been out of it for almost two years, for the reasons listed in the previous paragraph. I was fried. I wanted to be a great doctor and meet my patients’ needs for prevention and treatment of disease, management of acute illness, and a compassionate, kind person to be on their side. But after 30 years, I couldn’t do it without sacrificing my own sanity. Still, in urgent care, the disparities, the uninsured, the folks who fell through the cracks remained a huge concern. Then the coronavirus pandemic started, and I was thrust into a few weeks of utter chaos with confusing new recommendations each day. I worried about safety, because we didn’t have clear guidelines around isolation and testing. Then my health system divided our urgent care sites, separating COVID from non-COVID. My site, a non-COVID site, had a massive decline in patient visits. Now I’m seeing injuries and chronic patients who can’t get in to see their doctors. I’m doing telemedicine, and wishing I had more patients each shift. I wonder where all the acutely ill patients we used to see with chest pain, abdominal pain, headaches have gone. Do they have MIs and appendicitis at home? Health care during COVID. I’ve been watching the economic disaster and the insane politicization of this health crisis. Our government couldn’t pull it together to provide appropriate testing and contract tracing. Our leaders are willing to sacrifice health care workers, other essential workers’ and low-income communities rather than to obtain adequate PPE. Some started protests against stay-at-home orders, storming around armed with assault weapons. They, too, feel that the sacrifice of vulnerable lives is warranted in the name of “freedom” and “the economy.” They declared expertise worthless and subscribed to distorted statistics. Meanwhile, much of the health care workforce has been furloughed while health care executives and administrators take bonuses. States are now opening up haplessly, without testing or tracing in place. All the while, the public has started profusely thanking beleaguered frontline workers, calling those who show up for the everyday heroes. Banging pots, singing, sending food. Last week, health care workers got a military flyover. I am so ambivalent. I want those who risk themselves to serve others to receive the gratitude deserved. But I’m also concerned that it took this to get us there. Medical professionals have been working themselves into the ground for our patients for years and years before COVID. We had an epidemic of physician burnout, depression, and suicide going on before COVID, and there wasn’t much concern. Now that a bunch of health care workers has died en masse, people are paying attention. Other essential workers, like grocery workers and custodians and transit workers, have been underpaid, uninsured, and abused by our society for years. Few people paid attention before COVID. And while the heroes are being celebrated, they have not been protected, or properly cared for. Look at Dr. Lorna Breen, the ER doctor in New York who died last week by suicide. Where were the things she needed? Adequate PPE, adequate staffing, on-site mental health support? Free coffee is nice, but it doesn’t help in desperate situations. So look back at health care before COVID and health care during COVID. Don’t let the pot-banging and the flyovers distract you. We have to get through the crisis, which is not over by a long shot. We need the tools to do it: testing, tracing, PPE, staffing. We need to get the non-COVID patients back in care, clean up the mess, get ready for what’s next. And we need to care for everyone who has become exhausted, depressed, demoralized, and sick from doing COVID battle without needed support. Now look ahead. Life after COVID. Once this calms down, what do you want from the health care system? We can’t go back to the way things were. We were failing. We can’t have uninsured citizens in a supposedly civilized country. We can’t have insurance tied to employment, with the constant risk of losing coverage. We can’t have 60 percent of physicians burned out. Not if we want to be healthy in good times, and certainly not if we want to survive another crisis. Medical professionals need to lead the charge because we clearly see what is at stake. We’ve been willing to suck it up and pick up the slack silently for way too long. Life during COVID made it clear that there’s no slack left, no more room to suck it up. Let’s make health care after COVID better health care for our country. Rosalind Kaplan is an internal medicine physician who blogs at her self-titled site, Dr. Rosalind Kaplan. Source
