Episode 33 – January 2022: Physicians Cope with COVID

Julie: This is BACON, brief ACO news from the MaineHealth Accountable Care Organization, an artisanal monthly podcast for health care providers. I'm Julie Grosvenor.

Mike: And I'm Mike Clark. Julie and I are practicing physicians and liaisons with the MaineHealth ACO.

Julie: This month, we check in with four physicians from across Maine and ask them how they're doing as the pandemic drags on and intensifies.

Mike: Yep, and they've got a lot to say. So let's dig right in.

Meaty Topic...

Julie: It's impossible to be in Maine or in health care without the pandemic dominating pretty much everything you do right now. We're in the midst of a Delta surge that's turning into an Omicron surge, and we've had patients who've delayed care, returning sicker than ever before. It's putting a lot of strain on both the system and the individual providers and care team members.

Mike: That's right. And so, we wanted to get a sense of how our peers are experiencing the pandemic right now. So, we reached out to four of them in different locations around the state. We asked each the same set of questions about current conditions on the ground and how they're adapting,

Julie: Since they were all understandably pretty busy, we recorded each of them separately when they had a chance to step away from their day-to-day work for a moment. Then, we edited their responses together. So, in this segment, you'll hear us ask a question and then hear each of them respond, similar to a panel-type discussion. Joining us are:

Ross: I'm Ross Isacke. I'm the chief medical officer at Franklin Community Health Network, which is a MaineHealth Hospital in Farmington, Maine.

Don: So, my name is Don Medd. I'm the primary care director for the MaineHealth Medical Group Greater Portland Regions. I do that half of my time, the other half of my time I'm in my office. I'm a practicing internist in Westbrook, Maine, for primary care.

Kathryn: So, my name's Kathryn Galbraith. My husband, David, and I own Galbraith Family Medicine in Limerick, Maine. We've been running our own practice now for 11 years and really enjoying it, working in the community and getting to know our patients and caring for them.

Heather: My name is Heather Ward. I am a family physician. I've been a family physician for a little over 20 years now in Belfast. I'm also the medical director of primary care here at Waldo County.

Julie: We've entered the most intense phase of the pandemic so far. What are conditions like where you are?

Ross: We are seeing a lot of COVID. We're seeing a lot of people come into the emergency department who have been diagnosed previously with COVID or frankly are in with what they think is, you know, a heart failure, exacerbation, or some other problem they've suffered from in the past like pneumonia and are a lot of times frankly surprised that they have COVID. That's said, it's so prevalent in the community that it's touching virtually everyone that I work with right now. In terms of conditions here in the hospital as a result of this, we have a lot more people in the emergency department than we had this time last year. Certainly a lot more than the year before. That's multifactorial. COVID disease itself is affecting us dramatically right now, but the fallout from COVID disease is just as real a problem. We're still seeing delayed care where people didn't seek care during the early portion of the pandemic, trying to avoid getting COVID disease and coming into the hospital. So we're seeing a lot of people who didn't have access to care because they didn't seek it. We also are seeing people that didn't have access to care because we've struggled with that because of the fallout from COVID. We're seeing diseases of social isolation much more frequently presenting to the emergency room, presenting and admitted to the hospital people with, you know, the swell of alcohol use, people with liver failure, and then, frankly, people who are struggling with behavioral health-related problems, people with depression, people with anxiety, and are really remarkable, what we're calling a duo-demic here locally anyhow, in terms of COVID disease and adolescent behavioral health, we've struggled with this dramatically. So much so that at any given time in the emergency department here, we might have as many as ten people who are boarding in the emergency department with crisis. Most of those are adolescents.

Don: So, I would say the biggest thing that we're seeing in my practice in Westbrook is an increased request for booster vaccines from patients and concern about having COVID. Right now, the staff are trying to give two vaccines at the end of an appointment, that can take some time. And, as people may be aware, there's been a real staffing shortage in health care that hasn't spared primary care. So, you know, staff are being asked to sometimes support two providers at a time. And on top of that, they're doing two vaccines of flu and a COVID booster. And the COVID booster can take, you know, 10 minutes because there's consenting and you have to draw it up, and then it's just taking longer. And with staffing shortages, it's really putting pressure on the staff and doing the work for more providers than they typically support.

Kathryn: I would say at this point, most of what we're doing around the pandemic is educating patients. You know, we're fighting misinformation and hype around COVID and the COVID vaccines, trying to calm people's fears, you know, affirming their own feelings, whatever those are about the disease and the vaccines, tamping down some of the media panic being stoked and driving a lot of fear for people, and trying to relay information as best we can about the facts of things. And that's hard to do because this is a novel virus and we don't have a lot of facts and there are too many people out there claiming to be experts to know things that they can't know with a novel virus and then really confusing people a lot. So that's been probably the biggest thing that we've been dealing with is just trying to keep people informed as best we can and trying to take away some of the fear and frustration and anger that some people have around all that's been going on.

Heather: Yeah. So it's way more stressful and busy than actually we ever have been. You know, I feel like we got off pretty light in the beginning of the pandemic. We helped a lot with one of the early nursing home outbreaks, which was really time-consuming for some of us, but did not negatively impact our hospital, and now, really starting in mid-July or August, we have had significantly high numbers, both outpatient and in the hospital, and those, you know, they affect our staff because of staff illnesses. They affect our staff because of family illnesses that keep them at home. So, it's not just the number of patients, it's the number of care team members who are affected.

Mike: So tell us, what changes have you and your team made to try to meet the demand for care?

Ross: We've stood up COVID units here to manage patients. We've also changed the way we manage our precautions to minimize risk. So there's airborne precautions in parts of the hospital that we've discovered are too close quarters, et cetera. So that's happening. We've also stood up different ways to screen employees to get them back to work in terms of testing them more early and with point-of-care testing, which has been pretty exciting. And then the outpatient setting, we've had to implement a lot of structural changes too, in terms of, you know, who can come with someone to an appointment, what's safe to do that? What kind of masks can people wear? What questions do we have to ask to make sure they're safe to come into the office?

Don: We've tried to set up some special clinics in our offices to do additional vaccinations. So, there's been some weekend days where our offices have been open just for boosters. My office was, you know, did like 150 of them a couple of weekends ago on a Saturday. So, the whole staff came in and the providers came in to support that. So, just additional work on top of what we normally do.

Kathryn: In a typical winter, somebody had seven days of cold symptoms, we're bringing them in to see them and check them out, and now we're saying, yeah, you've had seven days of symptoms, maybe this is COVID. You need to go somewhere else to get tested or you need to stay home and continue to nurse yourself at home if that's appropriate, while at the same time as trying to keep people out of the office, in that regard, we're also trying to lure people in who are reluctant to come. So people with multiple medical illnesses, diabetes, heart disease that haven't been taking care of themselves in the last year and a half really need to come in, and trying to convince them that that's important and that it's safe to do so has been another challenge. And then just trying to manage supply situations, we from the get-go as a small office have not been able to get appropriate protective equipment. We haven't been able to test at our office, and we still can't get the appropriate equipment that we would need to do that. We're also finding we're having trouble with things like getting albuterol for giving someone with asthma nebulizer treatment. We can't get it. We've been told that we are, we can't get it, but we don't have an allotment because we're so small. We've been told we can't get lidocaine. So it's one of those things that we're trying to deal with, functioning with supply chain issues as well.

Heather: We see components or different staff members from every primary care office that gets pulled into testing and being part of our respiratory clinic where we see COVID-positive patients and take care of them before they need to be in the ED or before they need to be in the hospital. Every single primary care office has lost either an MA or a provider or a nurse to COVID care in our ambulatory setting. Myself and the physician assistant who works with me, Ainsley Price, we both have been out of our office about 50 percent of our time, and so, having both of us gone has obviously put a lot of demand on the other provider who is here, Corinne Grant. And that directly impacts our office practice and our patients.

Julie: How have you adapted personally?

Ross: Very early on, we, as with everyone, lost our school, we lost our child care. Daycare closed and I was extremely fortunate that I had my parents nearby to care for my kids. The huge downside to that was we didn't know much about COVID in the beginning, and my folks are, you know, not as young. And ultimately, what we had to do to keep them safe because we were coming and going was leave my kids with my folks. So a couple of times during this pandemic, for several months at a time, my kids had to be away before we got to the point where my family was vaccinated, where I was vaccinated, where my oldest child now is getting vaccinated. We're in a much better place in that regard, but that was a pretty dramatic thing that had to happen for the safety of my family and for us to be able to keep working early in the pandemic.

Don: You know, I've taken some of my own administrative time to support vaccine efforts. And some of us have been asked to come into the hospital to help support the hospital. So, you know, there's only one of a clinician and there's multiple things to be doing right now, and the priority is preserving, you know, access to acute care in the hospital and supporting the hospital. So, it creates just a little bit of anxiety about what we're missing in normal primary care.

Kathryn: Well, I would say that our lives, my husband and my lives, have been consumed by the practice and caring for folks and trying to keep up-to-date with the latest and greatest information that we can get on COVID and how it's changing. Trying to run the business, like I mentioned, supply chain things and, you know, trying to get money from various relief funds and that sort of thing really occupies a lot of our time. And so there's not a lot of personal time, a lot of human time. We try to do what we can. We've been fortunate to be close with our kids who are college-age and they're actually now home for the holidays, so getting to spend time with them. But it's basically stealing moments here and there to watch a little TV or get a little exercise or you know. But yeah, it's been pretty consuming.

Heather: I think one of the things that I've really tried to focus on is making sure that I have time for exercise and time for my family. I mean, there definitely have been situations where I've chosen to give up a vacation because we were in a really significant crunch at the moment. But knowing that that is important to not do very often and to take that time with my family is something that I have been refocusing on and just basic care, trying to get sleep and trying to eat well and exercise.

Mike: Let's face it, it's tough right now all around Maine. What words do you have for your provider colleagues across the state?

Ross: I have the benefit of having worked at two other health systems fairly recently, at Western Maine at Stevens Memorial and Maine Medical Center as well, and I have to say that this is stuff that we're feeling everywhere and that everyone is struggling with. It was, you know, very easy to be at a receiving hospital and think, boy, we just, you know, all the patients get sent to us. And it's not until I did a lot of work at these other hospitals that I realized we're struggling with the same issues and we're fighting the same problems. And really we truly are all in it together. And what happens at Eastern Maine Medical Center dramatically affects what happens to me here at Franklin and Maine Medical Center, and we are truly all doing the same thing. We're all trying to care for patients as best we can in a tough situation.

Don: Yeah, I mean, I would say, you know, that we're just incredibly grateful for what the hospital is doing for the community right now. You know, it seems like the pandemic has really burdened those providers the most and we can't really thank them enough for what they're doing. I think we really feel like we're, you know, the health systems, super team member, super teammate, and we want to do everything we can to help lessen the burden in the hospital. So, you know, that would include doing everything we can to get our patients vaccinated, you know, making sure that we get outpatient treatment where we can get it. And, just to do our role, do our part in what is right now a surge of COVID.

Kathryn: Well, I have to say, much like many of our patients, this whole COVID experience has been very isolating. We've felt out on our own, you know, doing the best we can with our own resources and, you know, finding it hard to connect. And I would say to other providers, we'd really love to collaborate more. I know that a lot of the specialty offices are under a lot of stress right now with trying to get people in with staffing issues. Appointment availability is very difficult and we're struggling to try to get our patients in and they're struggling to see them. But you can only do what you can do, and it feels like we're all out there in our own little world of stress and not really collaborating in ways that we might be able to help each other. Maybe talking more directly. So I would say less isolation would be what I would encourage from everybody.

Heather: I think one of the things that I have learned over the last six months is, I think, a little bit more acceptance. I was certainly pretty angry as I'm sure a lot of people are experiencing now. In July and August when we started our surge and it could have been prevented by vaccination, it was pretty easy to be upset with people who have chosen not to be vaccinated. And I feel like I am finally moving through that to acceptance, and hopefully even to having compassion for people who have chosen not to be vaccinated because they are still my patients, still people who I've had long-term relationships with. And getting back to having compassion for people who might not have made the choice that I wanted them to make has actually been really good for my longevity, for helping me feel like I can continue to do this work and I can continue to take care of patients, even in this really stressful environment. So, I guess, I would encourage everybody to remember that our patients make decisions that we don't agree with all the time and we still take care of them with empathy and with compassion. And at least for me, moving back into that mental space has been really, really good.

Julie: Finally, how are you feeling now? What do you think about your future, our future?

Ross: Despite everything we hear, despite Omicron, despite Delta, despite all of it, I'm pretty hopeful. Not that this whole COVID thing is going anywhere. It's not. COVID is going to be a part of the way that we deal with each other and the way we deal with health care for the foreseeable future, but it isn't going to be relevant. I truly don't believe that it's going to be relevant the way that it is now, in the future. In the future, we're going to have better treatment modalities. Those modalities are coming out very soon. Merck's drug and Pfizer's drug are right around the corner. One of those actually promises some pretty exciting results and also promises results that probably aren't readily mutable against. So it looks like in particular, Pfizer's drug as a protease inhibitor is actually going to do pretty well to prevent hospitalizations and make this less relevant. The more that we vaccinate, the more we boost, and then, unfortunately, the more people who get disease naturally and recover, the more people have some immunity to this. And so if they were to get a variant in the future, they're less likely to get severely ill. And naturally, viruses are going to mutate towards less harm as we co-evolve with them. And so, I truly believe that this is going to become less and less relevant in the future. And so I'm hopeful about that. And I'm also I'm really impressed at the way COVID has made us accelerate a lot of the work that we already wanted to do and made us think about things differently. I think a lot of really good stuff has come out of this, and if nothing else the mRNA delivery method for vaccination and potentially other therapeutics. This is, you know, move that forward 10 years. I think it's going to really help us with a lot of other illnesses. So overall, I am hopeful for the future, for this being less relevant, and I'm also hopeful that we've taken a lot of good away from this terrible tragedy.

Don: More of our population has been vaccinated and is getting boosters than has not. So, I think that is reason for optimism. I think, you know, it's cautious optimism because, you know, there's these variants out there, and if, you know, I can't even think of a variant that evades the vaccines altogether. But I'm thinking about the gradual increase in vaccine uptake and, you know, looking forward to spring when hopefully things are settled down again.

Kathryn: We're going to get through this. You know, I have no doubt about that. I think there's going to be some bruises along the way. I think a lot of mental health stuff is showing itself through this, but I think we're going to learn how to live with COVID. We're going to learn how to how to be, how to manage it, much like we manage the flu season every year and it's going to be a background piece of things, and I'm looking forward to that day. And it's coming. You can definitely see things are better than they were in March of 2020. Hopefully, March of 2022 is, you know, that much better than March of 2021, and we just keep going forward.

Heather: I feel like this is going to be something we've had to adapt to and we'll need to continue to adapt to. I don't anticipate this going away. I feel like it's going to become part of what we do more on an everyday basis and, learn how to live around it and with it, as opposed to stopping and making it go away.

Julie: Thanks for listening to BACON this month, you can find all our episodes on your podcast app and at our web page MaineHealthACO.org/BACON. And if you have questions, comments, or suggestions, we'd love to hear from you, as always. Please email us at bacon@mainehealth.org. That's bacon@mainehealth.org.

Mike: BACON is produced by the MaineHealth Accountable Care Organization with help from MaineHealth Educational Services. Thanks for joining us. See you next month!

Julie: See you next month!