Times Chronicle & Public Spirit
Medical professials see more challenges on the road ahead
The COVID-19 pandemic has forever changed the lives of medical professionals.
More than two years into the global public health crisis, these frontline workers have continued to help those in need.
“It definitely felt like we were kind of responding to the needs of our community and our country and really brought out the best in people,” said Dr. John Russell, chairman of the Department of Family Medicine and Director of the Family Medicine Residency Program at Jefferson HealthAbington.
The first cases of the novel coronavirus were detected back on March 7, 2020. Colleen Price, a nurse Einstein Montgomery, had interacted with a COVID-19 patient at her hospital.
“When somebody’s in respiratory distress they have a certain look. You start to know what the disease looks like … ,” she said. “This person was young. He’s alive thank God. He wasn’t in a horrible amount of respiratory distress, but he had a little bit of shortness of breath to him that I knew whatever this virus was, I just (instinctively) knew he probably had it.”
Russell likened his experience living and working during the COVID-19 pandemic to “building the airplane as you were flying it.” A family medicine physician by trade, Russell was tasked with setting up a COVID-19 testing site.
Many clinicians across the greater Philadelphia region never expected to face an outbreak of this magnitude in their medical career.
“I think for physicians, we prepare, and learn about what could happen if there were a pandemic, but we never imagined that it’s actually going to happen. It seems more like an academic exercise,” said Dr. Christopher Notte, senior vice president and associate chief medical officer of Jefferson Medicine Group. “I don’t think that I ever dreamt of what this would really look like and what it would really mean to face something like this.”
As cases counts mounted, area hospitals were inundated in the pandemic’s early days.
Death followed.
“I saw a lot of people pass away. I saw a lot of people pass away by themselves,” Russell said. “I’ve seen a lot of people who’ve had delays in diagnosis of cancers and things like that when the world was shut down.”
Work also continued for physicians in primary care settings charged with tending to their patients dealing with a myriad of ailments ranging from diabetes to high blood pressure, observed Dr. Randi Zeitzer, a physician at Broad Axe Family Medicine in Blue Bell.
“A lot of care stopped but primary care didn’t,” Zeitzer said. “Patients still needed to treat their basic medical issues. A lot of it we were able to do over originally the telephone, and then as we got our technologies settled over the video so that we could still monitor patients’ diabetes, we could still treat their high blood pressure, their cholesterol.”
Zeitzer recalled looking back on early entries within a journal she kept during the pandemic.
“We didn’t see common colds because nobody went anywhere,” she continued. “We didn’t see stomach virus. We didn’t see strep throat,” she said. “Our only illness was pretty much COVID during that time.”
Other medical professionals faced obstacles as they pivoted, encountering new ways to treat their patients remotely.
“Initially, it was hard. I really like seeing my patients,” Zeitzer said. I have some older patients that I would give hugs that I’ve known for a really long time. So talking to somebody on the phone and not having the visual was really hard for me. It was like there was somebody at the end but it wasn’t really real. The video visits were great. I could see my patients.”
With ebbs and flows and several variants of the novel coronavirus presented lessons for health care professionals.
“I think everyone is going to be more mindful of every infectious disease, every kind of infection control I think going forward,” Russell
said.
And it hasn’t been without its challenges.
“I think the last two years have been very challenging for anyone in health care, certainly anyone who is a front line worker,” Notte said. “While a lot of folks have been able to work from home, the people in my world haven’t had that ability.”
“We have to go to work to serve our patients, and we are a key part of the function of society. When people get sick they need to be cared for and we need to do that,” he continued. “That’s our sort of moral obligation, and I think as a result of that, when you have moral obligation you also have the risk of moral injury, and I think that people have really been hurt by the pandemic, and I feel for those people that I serve.” Russell agreed.
“As a country I think about 25 percent of people have left health care and I think it’s been something that we really haven’t expected,” he said.
Price shared her struggles reflecting on the past two years.
“They have been probably the hardest, most emotionally mentally physically draining two years of my life,” she said. “Honestly, I’ve never experienced anything like this. I’ve worked in a hospital for over 30 years, and it’s been the hardest two years of my life.
“It’s trying. It really is trying. People are tired. There’s no doubt about that,” said Dr. Charles F. Barbera, senior vice president and associate chief medical officer at Tower Health.
Notte observed his view of the state of morale among medical personnel.
“I would say that people still feel the strong obligation to serve,” Notte said. “I don’t think that’ll ever go away, but I would say I that the energy that came early in the pandemic as people desire to serve and heal has waned some, and now at this point I would say there’s a great fatigue amongst health care workers, and the best that we can do at this point is acknowledge that and to try and support them through that however we can.
But Barbera acknowledged the strength of health care workers who have “a certain energy, drive, resiliency and so people don’t give up” as they deal with the ongoing public health crisis.
“The medical community here: nurs(es), physicians, advanced practitioners, advanced practice professionals, they are resilient, and they are by and large hoping the pandemic’s behind us, but preparing for the next wave as well,” he said.
But Russell noted that it could take some time.
“I think it’s going to be a while until health care feels rebuilt, and I think for a lot of people who were deep in the pandemic, I think people are going to feel a little bit shell shocked for a while, And I think we’ll be a little bit anxious and a little bit nervous for things,” he said.
Clinicians across the region have learned lessons from the COVID-19 pandemic that have changed their routine. For Russell, it was a key accessory.
“People wearing neckties in the office. A lot of the affectations I think are different,” he said. “I worked in an office where no one ever wore scrubs and we’re still at a point where probably about half the time doctors are wearing scrubs now.”
“I wear a necktie almost every day because for me maybe emotionally it’s a sign of trying to return to normalcy, but for some people say it’s something else to worry about touching the wrong thing, etc. so maybe we should never wear a tie again,” Russell said.
There were also shifts in patient interactions.
“Can you shake a hand? Can you hug a patient?” Russell asked.
These day-to-day practices span from more stringent personal protective equipment usage to Telehealth.
“There will be a greater sense of vigilance about infection control on a personal level where I think more providers will take additional precautions like mask wearing and other things,” Notte said. “Even if the pandemic were to become a thing of the past, I think that people will be more mindful of it, and more thoughtful of it, and so I think that will certainly change the way people will look at seeing patients in person.”
“But I think that leads to the whole discussion about telemedicine,” he continued. “I don’t think that telemedicine will ever replace what we do in the office, but it will certainly complement and become not a novelty but instead part of just delivering medical care. I think we now see it as one more tool in the arsenal and it’s not an unusual tool, it’s part of the way we deliver care.”
While the advent of Telehealth predated the COVID-19 pandemic, health and safety concerns associated with close contact made it a necessity.
“I think Telehealth is here to stay in some way shape or form, and I think thinking Telehealth is going to replace all medical care is not true, but I think there’s some great opportunities that Telehealth could be something regular,” Russell said.
Mary Bilotta, Tower Health’s assistant director of Telehealth, noted that remote patient care takes shape in the form of asynchronous and synchronous options. While synchronous allows for a virtual meeting with a health care provider, asynchronous covers a more remote scenario such as sending a message to a doctor with a photo.
Barbera noted that “the use cases are endless.” He added that patients could use Telehealth for numerous reasons ranging from a cold to a rash, but acknowledged some difficulties with registration and payment.
Telehealth offers an opportunity to have a conversation to see if further inperson care is needed, Billotta found.
“I think there’s going to be a benefit of creating a hybrid model; being able to mix, and again ensure that patients are getting the appropriate care at the right time based on their level of symptoms and acuity,” she said. “I believe that there is space for each as there should be,” she said.
“There is never going to be a time that physicians should not touch a patient physically and be able to listen to their heart and be able to really make that in person connection,” Bilotta continued. “However, we know that with today’s times, and the ever evolving — maybe different strains of COVID continuing to pop up that there is going to be the utility of creating virtual space for those patients.”