How Does A Pandemic Alter Patient Care?

Written by Catherine Lewis Saenz

On her first day as a Physical Medicine and Rehabilitation Intern at Mayo Clinic School of Graduate Medical Education, Melanie White, DO ’20, found herself in an unusual situation. Her patient, an elderly man with a terminal illness, had been brought in to the hospital from his nursing home and his condition was quickly deteriorating. In a pandemic, however, the obstacle she faced wasn’t how to provide him with the medical care he needed.

The coronavirus’ ease of spreading, especially in how it remains airborne indoors for long periods of time, has triggered a slew of protocols over the past seven months that differ from one healthcare facility to the next. Navigating that process on the first day of a medical internship was no small feat. In addition to discussing her patient’s goals for care over the phone with his family–which she did not feel equipped to do on her first day–Dr. White also needed to coordinate family visitations.

“We did everything that we possibly could to get him into hospice to be closer to his family,” said Dr. White. However, because of his comorbidities, her patient could not be transitioned from the care he was receiving at the hospital to another facility closer to home. For days, while she advocated for her patient and coordinated with others in charge of his care, she watched him diminish without his family to comfort him.

Sadly, in the end, the patient passed away before his family could see him. “That really has affected me,” said Dr. White. “When we previously had a patient in this situation, it would not have been a problem to get them closer to home or have family come in.” This inability to offer patients the comfort of having their family with them, an important part of healthcare delivery, has been one of the more heartbreaking outcomes of the coronavirus pandemic.

Dr. White shared her story with almost 80 students, faculty, and staff from both RVU campuses as part of an Alumni Panel discussion held in late September. The panel brought together four of RVU’s recent graduates—Dr. White; Shayna Popkin, DO ’19; Alexa Tyler, DO ’19; and Kashyap Kaul, DO ’18—to talk about their experiences as residents during the pandemic.

One of the most significant adjustments for the alums was donning Personal Protective Equipment (PPE), but not for the reasons one might think. While donning PPE requires planning ahead, it can also hinder the social aspect of patient care. “If you haven’t been in the hospital, treating in PPE, it’s hard to know how alien you look. We can’t smile or show our faces. We can’t connect with [our patients],” said Dr. Popkin, currently a Psychiatry Resident at George Washington University.

“The patient aspect of it [is] definitely jarring,” said Dr. Kaul. As the Resident Medical Director of Northern Valley EMS and LVHN-MedEvac, he has seen cardiac arrest patients during the pandemic that have much worse outcomes than before. “We are not even transporting these patients [in ambulances] because we [would not be able to] resuscitate them,” he explained, as it would take ambulances—which now need to be deep–cleaned after each usage—out of service for longer periods of time. In the Emergency Department, where he is also an Emergency Medicine Resident at Lehigh Valley Health Network, “We have to stop and think [with every patient]: what is this going to do for our exposure? What is this going to do for the exposure of every nurse?”

While the pandemic altered patient care in complicated ways, residency programs themselves did not change too much, at least according to some of the alumni. “It was amazing how normal it was for [my residency],” said Dr. Popkin. “I was really struck by how the [outside] world changed because every day, I had been at the hospital. It was hard to realize what was happening to the rest of the world.” Dr. Tyler added that “in some aspects, intern year is just intern year. You go in not knowing what it’s like…you’re just going to feel tired and inadequate. From that standpoint, I don’t know if it felt all that different.” Six months later, treatment for patients with the coronavirus are carried out using an evidence-based approach, not panic, a slow return to normal.

Another outcome of the pandemic has been prolonged work hours, sometimes up to 100 hours a week, according to Dr. Popkin. With physician burnout a concern before the pandemic, it’s now more important than ever for residents to spend time on self-care. Dr. Kaul emphasized that finding alternatives for relaxation is an important way to maintain one’s sanity. While part of a physician’s skillset is to be adaptable, it should never come at the cost of one’s mental or emotional health. For Dr. Tyler, Family Medicine Resident at Oregon Health and Sciences University, it’s important to remember that “you are a human in a profession that is often asking you to be more than that.”

A physician’s ability to adapt in an ongoing pandemic will also stem from their medical education. When it comes to research and treatment of COVID-19, Dr. Kaul believes he is able to evaluate the literature and understand the components of a study as well as he can because of his training in medical literacy at RVU. For Dr. Popkin, the times spent at RVU honing her skills in teamwork also paid off. “An important thing to learn as an intern – pandemic or not – is to find your place on a team…and to be the best player on that team.”

If you are an RVU student, faculty, or staff member, you can watch a recording of the Alumni panel at https://bit.ly/36Q5587.