One of the items on our daily huddle checklist at my office is “Potential Bottlenecks" (work slow-downs), and over the past few weeks Allison, my medical assistant, has pretty much said the same thing every day when we come to that item: “Every patient is going to want to talk to you about COVID!”
And she’s right.
EVERY. SINGLE. PATIENT!
That’s OK, by the way. Especially now, engaging our patients is an even more critical part of our job: dispelling misinformation and giving our patients solid, evidence-based guidance. For the most part, my discussions with patients can be grouped into four buckets:
1. “I think I have COVID.” You know these patients. Maybe they are in your office (or on your computer via telehealth) for an acute appointment, or this is their chronic disease check-up. Regardless, these visits involve the patient describing their symptoms and wondering if they have COVID. And as we’ve learned more and more about this virus, the symptoms are becoming broader. The current symptom set includes many non-specific symptoms, such as fatigue. As the prevalence of coronavirus increases, so does the positive predictive value of these symptoms, so we all must be alert and ready to react. From an outpatient perspective, supportive therapy is still the goal. Anti-SARS-CoV-2 monoclonal antibody treatment holds some promise.
2. “I think I was exposed to COVID.” This represents the majority of my interactions. My first question back to these patients is “What do you mean you were exposed?” In other words, briefly passing someone in the hallway who eventually tests positive for COVID may not count as an exposure. Spending Thanksgiving Day with someone who tests positive probably does count, per the CDC definition of close contact.
The guidelines for quarantine were updated on Dec. 2 and now include 7-day and 10-day options, in addition to the 14-day standard. See the algorithm we created, but keep in mind the virus hasn’t changed: New quarantine guidelines were developed to balance the needs of a burdensome quarantine against the epidemiology of the virus. The safest choice is still the 14-day option.
3. “The vaccine.” It’s all about the vaccine at this point — or at least it seems that way. When we look to the future and think about how we return to "normal," there are three arms: mitigation, treatment, and prevention. And the promise of the various vaccines in prevention of COVID is both exciting and nerve-racking.
The most common question I get about the vaccine is “How can I get on the list, doc?” And my answer is, as of today, “I don’t know.” There is a state-by-state approach to vaccine distribution, with some guidance from federal bodies such as the CDC and the National Academy of Medicine. Most states are focusing on the high-priority, phase-1a group — those on the front lines of dealing with coronavirus patients. I have encouraged my patients, my staff, and my colleagues to stay informed, as information is changing on a daily (and sometimes hourly) basis.
There are many unknowns about these vaccines, but thus far according to media reports they appear to be safe and effective. See the AAFP's COVID-19 vaccine safety and efficacy data overviews. As physicians, we can lay the groundwork for vaccine acceptance by educating patients about the rigorous testing the FDA requires before it approves vaccines, as well as the ongoing monitoring of adverse events that takes place after approval. But studies show that the most effective thing we can do is to talk to our patients about our own plans to vaccinate ourselves.
I have also gotten many questions about mRNA vaccines, as there seem to be many misconceptions on social media about how mRNA vaccines work. I have relied on and directed my patients to a CDC site that directly answers all vaccine-related questions. It’s really quite good at dispelling the misinformation. Speaking of misinformation ...
4. “Misinformation.” this is the toughest group to deal with, in my opinion. Sanford Brown, MD, recently gave the best advice in FPM for how to handle patients like these: “The key is to avoid getting defensive or drawn into a debate, and instead just focus on the facts and move on.” Well said!
As we continue to fight our way through this pandemic, I’m encouraged that brighter days are on the horizon. I’m reminded of the quote attributed to Winston Churchill: “If you’re going through hell, keep going."
Let’s all keep going.
— James Dom Dera, MD
Dr. Dom Dera is a family physician in private practice in Fairlawn, Ohio, and a member of the FPM Editorial Advisory Board.
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