Why American doctors and nurses are ill suited to handle a pandemic

This statement includes me. Healthcare in America is different, both good and bad, than anywhere else in the world. When questioned, most Americans think of our country as leaders in medical technology and innovation. This pandemic is showing that perception to be far from the truth, as well as bringing to light the flaws in our training and how we practice when faced with a serious contagious disease.

Infectious disease pandemics don’t happen on our shores. We hear about Ebola in West Africa, dengue fever in South American, hepatitis and SARS in Asia, malaria in Africa, but we don’t experience the day to day reality of what that means. Our only experience is influenza, and despite the availability of a vaccine for this infectious disease that kills 30,000 to 40,000 each year, only around 40% of our population is immunized. Basic infectious disease precautions, such as hand-washing or staying home when we are sick, are often overlooked in our efficient and rushed society. Physicians have been shown to have the poorest performance in the hospital setting when it comes to sanitizing their hands between patients.

American healthcare is a disposable society. Nothing is reused between patients, even if it can be re-sterilized, to prevent cross contamination and increase infection. Three months ago we would have been reprimanded for wearing the same mask between two patients. Now we are reusing that same mask for a week. Surgical drapes and gowns are disposable. In my work in Haiti and Vietnam, almost all instruments are reusable, gowns and drapes are cloth and rewashed and sterilized, masks are worn until they are unusable. Healthcare in America needs to learn to use our resources better, especially in a time of plenty so that we have reserves for times such as these.

Most of us are highly specialized. As an ob/gyn, I have never managed ventilator settings and only performed one intubation in medical school. I would be ill equipped to help out in an ICU setting. The same is probably true for the majority of American doctors if we were called into service to start IVs and draw blood. In hot spots such as NYC and New Orleans, fourth year medical students are allowed to graduate early if they are willing to work in a hospital caring for Covid patients. These newbie physicians have more of the needed skills than those of us 10 years out from medical school.

As physicians and nurses, our daily work most often results in the recovery and improvement of a patients health. We are not accustomed to caring for a patient for 2-3 weeks, with all of the medical technology that we have available, and then seeing that patient die despite our best efforts. In places like New York City, health care workers are not returning to work as they are unable to psychologically handle the senseless deaths they see daily. America has not experienced a war zone on its shores since the Civil War. This is a war zone when it comes to death, an experience that other parts of the world have seen more recently.

Informed consent is something that is drilled into our heads from early on in our training. Patients need to be given all of the options for their medical care, free from our personal judgement, along with the risks and benefits of each option. Covid doesn’t allow us that luxury. Often, patients have to be intubated emergently and informed consent is not an option. When ventilators are in limited supply some high risk patients, such as those with a terminal disease, may be offered comfort care rather than aggressive management.

When Covid is still fresh in our minds, but not in our bodies, Americans and healthcare professionals need to reexamine how we can change our medical system for the better so that our future response to an infectious disease is more streamlined and less chaotic. We need to use the innovation that makes us world renown to equip us for a new tomorrow.

Health Care Providers are stressed….and it’s not what you think

I would like to thank everyone who has reached out to to health care providers and expressed their gratitude for our work. The sidewalk in front of the hospital is full of chalk messages of encouragement that we see when we walk into work each day. But unless you are a physician in a current “hot spot” such as New York City or New Orleans, the rest of us are spending our time waiting. Waiting for the anticipated surge of patients that most of us have not seen happen as of yet and hope that won’t happen. The anxiety involved in the wait can be worse than being in the battle.

In preparation for the possibility of a marked increase in cases, our clinic doors have been closed to the majority of patient visits. This is not only to decrease the risk to patients of sitting in a crowded waiting room, but also to decrease the risk of transmission to health care providers as well as to conserve the supply of personal protective equipment (PPE).

Although the financial focus has been on the layoffs in the hospitality industry, health care workers are being laid off in unprecedented numbers. Numerous ambulatory clinics have made the difficult decision over the past weeks to furlough a large contingent of their employees. If there are not patients coming in our doors to generate revenue, we cannot continue to pay the majority of employee salaries. Many of the staff that I work with are not only co-workers but also friends. Some have more resources than others. As a small business, we need to make sure that the business is there and viable when this is over, so that we are able to rehire our employees. Hospitals have asked nurses and operating room personnel to take paid time off as operating room schedules have moved to emergency only cases. Physicians are taking enormous pay cuts of 50% or more.

This list of stresses could go on and on but here are just a few more that I have heard over the past few weeks.

  1. Family members that work in health care. The majority of us, physicians, nurses, respiratory therapists, love our jobs and have passed that on to our children. Many of them have followed us into the profession of caring for others. My oldest son is an RN on the Covid rule-out floor in Vegas. My sister is an RN in a cardiac cath lab where emergency procedures are the norm and there is no time to ask a patient questions about Covid symptoms.
  2. As medical professionals, we are often the source of factual knowledge for our friends and family members. Now many of us are being asked questions about hoax-type cures, unproven theories about the origin of the virus and when this will end. My best advice is to follow whatever Dr Fauci says. He has been thru this before with other epidemics and speaks truth to power.
  3. The realization that many of us will probably become infected. Despite best practices, 10-20% of health care providers in China and Italy have been infected. The percentages in Singapore and Hong Kong were much lower as they had better access to PPE and fewer patients. That is why it is so important that Americans follow the simple rules of social distancing, handwashing and keeping your hands away from your face. The less of you that are in need of care, the lower the percentage of health care workers that will be infected. It will also give us time to improve our supply of PPE.
  4. The lack of leadership from the top of our country. Rather than implementing uniform best practices determined by a scientific, medical committee that has access to the latest world-wide information, we are forced to make up our own policies with the information that we can glean from our colleagues in the hardest hit areas. These policies often differ from hospital to hospital and create angst among employees as to what is most correct. While our colleages in Seattle and New York are taxed with caring for massive numbers of patients, they are also trying to disseminate what they have learned so that they rest of us are better armed for the battle.
  5. The realization that Americans will forget what science has tried to teach us. I continue to have pregnant patients refuse the flu vaccine (despite its demonstrable efficacy) so I can imagine that many Americans will refuse the Covid 19 vaccine in the future. This pandemic has demonstrated that co-morbidities such as diabetes, hypertension and obesity, can put a person more at risk than advanced age. Maybe the need to stay at home, go for walks to relieve boredom and cook real food will give Americans an incentive to consider further beneficial lifestyle changes in the future.

Thank you again for your thoughts and words of encouragement. Just realize that our stressors are some of the same as yours…but also different.