Hello, Opportunity Here. Is Anyone Home? — COVID-19 gives us a chance to re-make our healthcare system for the better

Restart? Revamp? Revive? Renew?

No one’s totally sure what we should be calling this, this reconfiguration (maybe that’s the word?), but it must be the brave new world of how we practice medicine in the post-COVID-19 era, on the downslope of the pandemic we’ve just come through, and then on to the future of healthcare.

We are emerging slowly, brutalized and somewhat bleary-eyed, but looking forward to figuring out what our new normal is, how we will continue to take care of all of our patients who’ve been kept away from care due to fear, home quarantine, and home isolation — terrified of coming into our practice because of this new contagion. Also, we’ve had to rethink our systems to prepare for potential next waves — both big and small, sooner and later — and adapting to the new world of telehealth and video visits, remote patient monitoring, and more.

All while our institution is in the middle of an enterprise-wide transformation from one version of our electronic medical record to a shiny new model. We need to be more thoughtful as to who comes in and who stays home, and get much better at taking care of both of these groups, much better at almost everything we do.

Improving Screening

As I’ve written before, we need to get better at screening, making sure that those patients who might be infectious to others and can safely be cared for at home can truly do this, and those who really do need to come in can continue to do so safely as well. This involves screening at the time an appointment is made, and intervening by offering patients video visits instead of making them come in. Then we re-screen the day before an in-person appointment, when we confirm they are really coming in and have transportation all set up, and screen them once again when they arrive at the practice for their appointment.

Just recently, at the entrance to one of our hospital buildings, while I was walking by, I heard a screener saying to patients “Any symptoms? No, do you know where you’re going?” all in one rapid breath of an exhale, seemingly too bored or annoyed to fully enumerate all of the symptoms of COVID-19 that is the whole point of screening, what we need to know to safely let them in. Bad screening is not much better than no screening at all.

Many patients clearly don’t want to be screened; they just want to be let by. They often blast past the screeners, trying to justify it by saying that they’re late for their appointment, or that they know where they’re going and, “Who are you to question me?”

Feeling Our Way

Once in the practice, we’ve been separating those patients who might have COVID-19, what is called a PUI (person under investigation), from those patients who are here to have us take care of their diabetes, their hypertension, their low back pain, their asthma, their depression.

Staff at the front of the practice, who are greeting and registering the patients, are figuring out how much personal protective equipment (PPE) they should wear (Double masks? Gloves and gowns? Really stylish hair bonnets?), as are the medical technicians, the nurses, the doctors, and the nurse practitioners.

Everyone’s sort of feeling their way, reading the Infection Prevention and Control recommendations, but somewhere in the back of their minds, they’re thinking, “Are we sure they got this right? Wouldn’t it be better if I erred on the side of too much PPE, even if I’m not planning any aerosol-generating procedures?”

None of us want to read a journal article next month that suddenly, lo and behold, announces that we’ve been doing it wrong. And many have seen images of providers in other countries treating patients while wearing hazmat-level moon suits.

Patients still remain reluctant to come in, fearful of leaving their homes, fearful of encountering infected strangers on the streets, in the subways and buses, in the lobbies and elevators and waiting rooms. Some just dread arriving in a building known as a hospital or doctor’s office. Over the past few months, it seems like these have been places where people have come — sad but true — to die.

That’s how it felt to many on the outside, and, horribly, that’s how it’s felt to many of us on the inside. I can’t tell you how many of my fellow providers at the practice have been overjoyed when finally seeing their patients live in the practice, and how many have told me that both patients and the providers have teared up at seeing each other once again, starting to re-establish that all-important in-person relationship, that bond we have, that we’ve missed out on by just having the computer, the phone, the video link.

What Lessons Can Be Learned?

Many providers and staff are still working off-site, either remotely from home or another office away from patients, and this, along with a significant decrease in the number of patients coming into our practice, has left the halls of our offices feeling empty and hollow, a shadow of their former selves.

As we continue to emerge, as the virus’s hold on our city continues to loosen, we hope it becomes safer to venture out. We hope that we will be able, through staggered schedules and strict infection control measures, to return to some semblance of the life we had before, the old way of taking care of patients. We can only hope that we’ve learned some lessons, and that we can find ways to do things better and to build more thorough, comprehensive, and error-free ways to put the patient at the center of the care we provide.

A recent survey conducted at our institution showed that patients who had a video visit during the pandemic would now be willing to accept up to 50% of their future care as video visits, with only 50% being in-person visits. We need to build a system that addresses all the needs of all of our patients and gives them the right care at the right time. The system should break down the barriers to care and illuminate, then eliminate, the inequities of insurance and bias, while also increasing access to primary care, preventive medicine, and all of the subspecialty care our patients so desperately need.

COVID-19, along with the current social upheaval our country is facing, has laid bare many of the challenges, problems, and glaring deficits of our healthcare system, and it’s up to all of us to take advantage of this time to find a way to heal the wounds, bridge the gaps, and get everyone the care they need.

Opportunity is knocking. We just need to let it in.