Originally appeared in the Fall/Winter 2020 Gazette
by Holly Marihugh
Q: How has your practice changed since the influx of COVID-19 cases?
A: First, patients just stayed away. When patients are fearful about their health, availing themselves of their primary care doctor or the healthcare system is an automatic response. In this totally unusual situation, a paradoxical response occurred and that was to stay away from hospitals and the doctor’s office.
Something that changed in response to that was a broad acceptance of telemedicine. Patients feeling, maybe not comfortable, but at least satisfied, with some kind of audiovisual communication with their doctor. We used email and telephone communication to preserve the distance that is necessary to make sure that disease transmission is mitigated. Medicare wisely decided to reimburse physicians for telemedicine interactions for the first time.
Q: Telemedicine had never been part of your practice before?
A: Never. We’d communicate with patients through our internet portal, which is imbedded into our electronic medical record, but a) there was no reimbursement, and b) the patients thought it was kind of ersatz. They wanted to be seen, and I wanted to see them. This pandemic has caused me to at least consider this model as an option for reimbursement and safety.
Q: What’s been most challenging about treating COVID-19?
A: The most concerning issue of the disease is that it’s novel. The virus wasn’t understood or described until December (2019). We have a very poor understanding of which patients are going to be asymptomatic, which patients are going to have mild to severe flu-like symptoms, and which patients are going to have multi-system organ failure, require ventilation in the ICU, and potentially not recover.
Q: What has gone well in meeting the challenges of the pandemic?
A: It was massively reassuring how well-prepared the NorthShore University Health System was for this pandemic. Nurses, the administration, the professional staff, the physicians who are employees of the hospital, the physicians who are in private practice, and the chaplains all pulled in the same direction. NorthShore’s response was par excellence. I cannot tell you how proud I am of NorthShore University Health System.
Q: Can you offer an example?
A: I’m the Chair of the Institutional Ethics Committee at NorthShore, and so the administration and I began thinking in early March about an ethical response to the pandemic. Examples would be the concerns of safety for caregivers and doctors, and things like scare resource allocation for patients during a crisis response. I think we did a proactive job.
Also, physicians and nurses just stepped up. When operating rooms were closed down for elective surgeries, you had doctors answering the telephones. You had cardiologists who usually work in the office, rounding in the ICU with a pulmonologist, essentially acting as a senior resident. Professional egos just disappeared. Everyone worked together in tremendous team fashion.
Q: What changes in healthcare may become permanent after the pandemic is over?
A: I think telemedicine will stay with us. Congregating patients in waiting rooms or in elevators at hospitals is going to change. For instance in my office, we just closed down our waiting room.
There’s going to be continued high-level triage of patients who have respiratory or febrile illnesses. We will have to continue playing the COVID-twist on every presentation, and that’s going to require a few extra steps.
Patients will call and say, “I know this is strep throat, and I don’t have COVID,” and I still have to say, “‘Go to one of the NorthShore super-centers and be tested there first.’ That’s not me punting the patient; it’s a physician having to do what is right.”
Q: What changes in human behaviors may be here to stay?
A: There’s going to be less hugging and kissing of friends at social events. Congregating in bars and restaurants — especially in those cold months where the doors are locked tight and the windows are steamed up with everyone’s breath — I think we’re all going to have a second thought about doing that. Even though we live near the Great Lakes, al fresco dining is going to be the way to go.
Q: From a historical perspective, has anything you’ve encountered in medicine so far been as challenging as this period?
A: This is sui generis [unique]. There was the Spanish flu pandemic a hundred years ago. Clearly science and medicine were in a very different place at that time, but some of the same techniques that we’re using now to control spread and reduce transmission were in place back then. ■