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By now we are all starting to row in the same direction as we do our part to save lives in the COVID-19 pandemic. If you have not joined in, please get in the boat and place your oar in the water, we need you!
For some rowing is as simple as making the choice to shelter yourself as our public health officials are recommending. This provides personal safety, but it also reduces the propagation of the virus. This requires adaptation from the normal independence and liberty that is built into our lives in the US. Even though you may feel like you are not rowing, you are by sheltering in place. Never forget this!
For those who are not home-bound including healthcare personnel of all flavors, and first responders, we are all part of the “essential workers” during the travel bans. We are exempt because we are needed on the front lines to care for the population. Our rowing efforts are more evident, but even our work is requiring a host of adaptations so we can remain synchronized in our rowing (ie: delivering care to the public). It is not “business as usual” by any means.
The assault of the COVID-19 pandemic on the world and the US has created many adjustments for all of us, with those adjustments and changes seeming to trickle down to us day by day. The synchronization needed right now for all of us in healthcare is enormous. That kind of synchrony is challenging when the adaptive processes changes day by day.
But as we row in the same direction, to accomplish the goal of mitigating the pandemic, we must adhere to the importance of listening to the coxswain who is helping to guide all of us.
I am thankful that our government is unifying and mobilizing our healthcare voices that stream through the CDC, The National Institute of Health, The National Academy of Medicine, Surgeon General, The Department of Health and Human Services, the Armed Forces, and The Whitehouse as they all work in unison as our coxswain. I urge you to listen to them, because if we do, we will propel ourselves towards the goal much more rapidly than if we don’t.
In my case, I have another steadying voice in the coxswain seat called my chief medical officer of our organization who distills the daily changes into actionable items in our physician network. I am thankful for her leadership during these days that we all sort through how our work flow and day to day operations need to change course.
From the view of a primary care physician in the Midwest, there are a lot of elements associated with rowing in synchrony.
Medically we have to balance the tension of managing both sick and well patients. Since I do obstetrics, this service line has to continue in it’s own orbit whether there is a pandemic or not. By the way, I do suspect our multiple week sheltering process will result in a very productive December and January! Additionally well children and their important immunizations must be maintained in some semblance of normalcy.
For the sick, I must attempt to keep them separated from the well patients. This is especially difficult in a waiting room that was not built with the “6 foot rule” in mind. So we have adapted and followed the national guidelines for creating a “respiratory viral evaluation center”. Fortunately our clinic building is configured in a manner that allows for single room to be designated for this that has outside access for patient entry, but can be totally closed off to the rest of the clinic. Our office manager graciously volunteered to vacate her office for this purpose, for who knows how long.
Telehealth has never been part of our medical care process. But now must be rapidly deployed. Primarily it is a method for keeping non-COVID-19 patients at home, and sheltered from others. Whether it be to manage their chronic disease processes, address acute problems that can be handled via video-chat, or simply sort out whether a patient needs to come to office or ER. Medicare has suspended all rules associated with process in order to safely keep patients at home. Even they have adapted. We will quickly learn how to do this and implement it on the fly. And the patients will have to be taught how to use their electronic devices at home to make this happen. Some of the elderly may need assistance from their family to share their devices to make this possible. All stakeholders are adapting to the current state in order to maximally protect the safety and health of patients. In order to keep patients away from healthcare facilities, normal and routine labs/xray/procedures will all be suspended. This includes elective surgeries and outpatient procedures.
Then there is personal protective equipment. We have discovered that there is not an endless flow of supplies. At this point, we do have enough, but we must become ever mindful of a rationing and safe re-use processes that allows for safe care for all. There is a lot of adaptation here, and at some point it may require even more creative adaptation such as the home-made PPE that are currently being used by frontline workers in hard hit places like New York. For example, one of the nation’s largest Catholic Healthcare Systems, Trinity Health, just launched an initiative to create and purchase millions of re-usable cotton masks. The old way has become new again in the midst of the pandemic.
Economically all of this trickles down to both private practice physicians and employed physicians. Ultimately all will take a hit with reduced income as many patients stay away from all healthcare due to the risk of mingling with the sick. They are listening to the coxswain! It will be months before all of this shakes out, but staffing needs will shift, patient care delivery will shift, and outpatient physician services will shift. All with negative economic consequences. Although I strongly favor doctors being incorporated, there is little safe harbor for physicians regardless of your business structure. The only exception of course are salaried physicians.
Even medical schools and graduate medical education programs are having to dramatically adapt their programs, experiences, and training environments during this unprecedented time. My son is currently getting ready to start his 3rd year of medical school, and the school has suspended many clinical rotations and experiences. Of course this will trickle down into rigid medical training programs and their block schedules that are stacked on top of one another. Getting “all hands on deck” while simultaneously attempting to train requires adaptation on many levels.
We are all adapting to day by day, week by week, while pensively monitor what is happening. We all hope our adaptions will cumulatively lead to reaching the public health mitigation goal of saving lives and “flattening the curve” within the pandemic. We adapt and wait, hoping it is enough.
The outcome will likely be much better if we are all rowing in the same direction with our adaptions, keeping our eyes on the coxswain who is directing, adjusting, encouraging, and steering us all in the right direction.
As you row and start to grow weary, I urge to continue to persevere and continue to to listen to your coxswain who is shouting encouragement, and instructions to each of us. The well being of our nation rests on our determination to stay the course, and keep rowing.
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