None of us has faced a pandemic of this magnitude before with so many hurdles, and it stresses us as individuals just as it does the health care system. How many things can we possibly deal with at one time?
We have limited time to learn about a new virus and the protocols needed to test and treat patients safely and effectively while also protecting ourselves and our staff with limited resources in an ever-changing environment.
We also must somehow keep pace with aspects of our practice that are unrelated to COVID-19. At a time when many are doing as much as possible by telephone or computer, patients still have addictions, chronic conditions and mental health issues. They still have babies. They still need refills. And so much more.
Family physicians excel at treating the whole person, whole families and whole communities. We know how to multitask, but really?! This strains even our well-developed abilities.
So, what can we do?
Here are a few thoughts.
First, do the same thing you did at your first code.
Take a deep breath.
Remember who we are. We are family physicians. Trained in breadth. Comfortable with uncertainty. Able to make practical decisions. Adaptable. Connected to our communities. Constantly looking for information for the best evidence-based decisions, but willing to do what seems best even if the path is uncertain. We are best able to provide sanity, advice and direction at the community level, skills that are desperately needed right now.
What do we most need so we can do that?
We need accurate, up-to-date information. Fortunately, the AAFP had been providing substantial and updated information on its website, during weekly Virtual Town Hall meetings and on social media. The CDC also has good information, and your state or local health departments and hospital-based health systems may have resources, as well.
Please be aware that while you are learning about COVID-19, you can earn CME credit. And the AAFP plans to roll out more options in the coming weeks.
We need testing. Fortunately, this situation is improving, although with significant geographical variations. More labs are doing testing, and the time needed to report results is decreasing in some areas. Anecdotally, a friend in rural practice received a patient's COVID-19 test result in 17 hours just a few days ago. (It was positive.)
We need to decide how to process and triage patients. You may have figured this out by now, but it wasn't easy, was it? Patient triage works best if coordinated with a community health system, particularly if there is a centralized place for taking samples. Keep suspected positive patients out of your office, if possible, by asking patients to call ahead before showing up on your doorstep. If necessary, place a sign on the door informing patients of this practice. As you train them to call in advance, or possibly email in some situations, make sure there is staff to handle this communication. If it is absolutely necessary to obtain samples at your office, have a designated staff person masked and in appropriate personal protective equipment available to perform it outdoors. Recent FDA recommendations suggest that patient self-swabbing for samples may be reasonable.
We need to look at changes in practice operations. The most impactful change happening in family medicine practices is the introduction of telemedicine. My system has ramped up rapidly, and this is not just happening in large systems. A colleague in solo practice implemented it himself two weeks ago and is increasing its use rapidly. Telemedicine has two invaluable benefits for us right now: It allows patient assessment without risk of contagion, and it allows continued billing for services at a time when many patients are choosing to cancel appointments and stay home. This seems like a brave new world in patient interaction, but I have heard it compared to traditional family medicine house calls. Now we can visit patients' homes in another way.
Our practices need financial stability. You should know that the AAFP has been aggressive in promoting this agenda to the White House, federal agencies and public and private payers. CMS recently approved Medicare payment for phone call assessment of patients (if you're not in telemedicine yet or your patient does not have a workable computer or internet access). The AAFP also has information on financial assistance for your practice through the Coronavirus Aid, Relief and Economic Security Act.
We will face more problems during the coming weeks and months. We need to remember that as family physicians, we are versatile, adaptable, practical problem-solvers, connected to our communities and accustomed to dealing with complex problems. Family physicians are an indispensable resource that our society needs as we deal with a pandemic that is in mitigation phase in most areas. But we need to be smart, coordinated and well equipped to do the job right.
As family physicians, we are all in this together, and we will work together to achieve the best possible solution for our patients, our communities, our staffs, our families and ourselves. Because that's what we have been trained so well to do.
Stay safe and stay together.
Dennis Gingrich, M.D., is a member of the AAFP Board of Directors.