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.