Whether you are an optimist, a pessimist, or a strict realist is likely to impact how you would project potential effects of COVID on the post-COVID world.
I would argue that from the medical-practical perspective, the three attitudes above are not mutually exclusive. As we often conclude when reading pro- and con- arguments for a new legislature, unrefined reality allows for enough mixed data and scattered observations upon which to base and justify either stance.
My approach here is more of realistic anticipation: what changes to our global emergency care practice environment may result from what we are experiencing today? Undoubtedly, such changes will affect trainees a lot more than seasoned EM providers.
Telemedicine
While by no means a new thing, Telemedicine has advanced exponentially over the last few months and has come to the forefront of medical care in terms of its scope, breadth, and practical applications.
I am what my spouse would call “technologically challenged” (if she were to put it kindly). Yet even a tech-doofus (me) has had to dabble in Telehealth over the last few weeks – both inside my ED and to reach patients thousands of miles away.
- TAKE-HOME: The earlier and the more you get exposed to Telemedicine, the smoother your future tele-practice will be. Telemedicine to EM today is sort of like what Ultrasound was to EM twenty years ago. I see an EM Telemedicine fellowship coming your way.
Local Resource Preparedness
Everyone now realizes that you need to have tucked away but keep readily available roughly two N-95 masks per healthcare worker per day for three hundred and sixty-five days, amen.
Which changes in how entire healthcare systems are financed are necessary is a huge comprehensive topic. But point-preparedness, as in being ready at the actual place where you and I live and work locally, is a much easier thing to wrap our heads around and become directly involved in.
- TAKE-HOME: Find others like you, cooperate, get involved, and make your voices and opinions heard and count. We do not know when the Penguin flu or SARS-5 will hit us, but surely they will and with a vengeance. There is a tacit hope we will be smarter and more prepared next time.
Provider Cross-Training
I do not know if golf practice makes you better at playing basketball or swimming at karate. But I do know that we have become so specialized, it is almost like there are hand specialists nowadays who will only deal with the left index finger.
COVID has shown all of us that it is not helpful to only possess knowledge and skills within the comfort zone of your specialty or sub-specialty.
As an EM doc, I have been okay with my ventilator and ARDS management skills. But the last few weeks have been extraordinary in reading up on anything from the forgotten basics of epidemiology and virology to palliative care. And that’s a good habit of keeping up for the future.
- TAKE-HOME: Get out of your profession’s shell and encourage others to do the same. EM standing for Everything Medicine has never been more true. We are kind of lucky that way.
Sorting Out The Trash In Medical Literature
It is one thing to be able to verbally shred a New England or a Lancet paper at a leisurely journal club; it is quite another to be able to apply new (or old) reported research to clinical practice without harming anyone.
In the times of YouTube anxieties and misinformation, the latter task becomes even more crucial yet difficult. COVID controversies ranging from antimalarials to early intubation are a prime example.
But the good news with COVID is that I think we have just been handed the requirement for a free refresher course on how to appraise medical literature critically. We have to do this under pressure, without much time, and, arguably, fighting with our own natural inclination that “to do something is better than doing nothing.”
- TAKE-HOME: Less YouTube, more journal clubs. Our relatively young standard of evidence-based medicine is being tested worldwide like never before. Let us wish for it to perform well and withstand all the temptations. And yes, you do need to become a pro with this one.
Patient Privacy and Empty EDs - As They Were Intended?
These points are controversial. But with medical information privacy requirements being loosened in many locations and with fewer non-COVID patients going to EDs, it is a valid question to ask: is right now how things should have always been?
Whether certain patients do not belong to an ED is a complex topic. Finding the golden middle between protecting confidential patient information and enabling providers to reach and treat patients most efficiently is likewise easier said than done.
For now, I am just inviting you to think about it.
- TAKE-HOME: It may be that things will never go back to how they were. Perhaps we have all overdid it with patient privacy laws that, for a long time, had trumped basic common sense. It may also prove that no one will suffer a dire consequence because they chose to call a doctor via video rather than to drive to an ED. Keep a lookout for good data.
Viruses In Focus
After decades and billions poured into research, we finally have stuff against HIV. Hepatitis and the herpes families are the two runners up, plus we developed a few effective vaccines like the MMR – but that’s about it really.
So much time and focus have gone into killing bacteria, we have somewhat neglected the other big guy. Until now.
- TAKE-HOME: Nobel price winner Joshua Lederberg once said that “The single biggest threat to man’s continued dominance on this planet is the virus.” You will likely be practicing during an era of unprecedented anti-viral efforts. Just like with bacteria, we may not succeed all the way. But as long as we do not all turn into zombies, it’s okay.
The Cure For The Common Burnout
Emotional exhaustion may indeed be the key factor in professional burnout for emergency care providers. But other factors contribute as well – including feeling unappreciated or not needed, and work seems routine and mundane.
We now have COVID, which has reignited the fire for many EM providers, no matter how deep are those post-N95 facial marks. Otherwise, why would one fly to New York or elsewhere right now “to help”?
Frontline medicine certainly takes its toll on you. But hardly anyone in our specialty should feel not needed or unappreciated anymore.
- TAKE-HOME: Wake up and go to bed humbled, proud, and lucky to be able to do this work.
The few changes I have listed come from a very long list. Whether they will prove to be overwhelmingly positive remains to be seen. Of course, future benefits do not negate the tremendous harm and suffering the pandemic has already brought and will continue to bring in the months to come.
But one thing is for sure: COVID is not the last time we are dealing with something like this. What your attitude and knowledge will be then, is up to you.
