Medicine can be better: COVID showed us how

I love medicine. I love being a doctor and helping people. I really love infectious diseases. I love that we can cure people, that someone can get a few weeks of IV antibiotics and resume their previous activities. I love that people on a ventilator with pneumonia on one day can walk the halls with physical therapy just a few days later. I love helping people recently diagnosed with HIV transition from “Am I going to die?” to “It’s just one pill a day?” And I love that I can ask the right questions, look through the right reports and help diagnose a patient whose presentation has baffled multiple physicians before me.

I hate the system. I dislike that I can’t follow some patients out of the hospital because they have the wrong (or no) insurance. I get upset having to make multiple phone calls to get a prescription of itraconazole filled for a patient with histoplasmosis. I’m frustrated when I am unable to find a home health agency to help a capable patient do their OPAT at home.

I was able to deal with those difficulties because my love for my job propelled me forward. There is no other option, I told myself, so just work as best you can in this broken system. Then the COVID-19 pandemic hit.

My first instinct, like many, was just to keep my head above water. In my community-based hospital system, I volunteered to rewrite policies. I learned about hospital engineering and could recite from memory the proper air exchanges per hour for various types of rooms. I led a physician task force that included representatives from my ID department along with those from pulmonology, emergency medicine, obstetrics and gynecology, surgery, hospital medicine and others. 

We discussed what we knew and what we didn’t. We talked about how to protect each other and all our health care colleagues. We debated the treatment du jour as clinical trials were starting to form, and we standardized our treatment plans as evidence became available. We would meet in the ICU to discuss a patient’s case — prognosis and treatment — with the nurse at the bedside. We walked through operating rooms and obstetrics units with all the stakeholders to discuss how to move patients in a way that minimized exposure to staff and other patients. We did everything as a team, including phone calls to family members and educational sessions for the rest of the hospital staff.

It was in all those meetings — clinical as well as administrative — that I reconnected with what should be at the heart of medicine: the patient. Those meetings, which were daily at first, then weekly, then monthly — and are nonexistent now — made me realize that this is what medicine should be. It should be physicians asking about evidence and best practices, discussing ways to educate staff and explain procedures to patients. It should be talking through difficult cases and scenarios in real time. It should be fighting for more PPE, more air exchanges and more focus on what matters — providing the best patient care. For a brief while, prior authorizations and insurance company peer reviews went away, and we got back to why we all went into medicine: to learn about disease processes with our friends and colleagues and to take care of patients as best as we can. 

I think a lot of the burnout that I'm suffering from now has to do with the fact that I got to see, however briefly, how good it can be when we all — physicians, nurses, environmental services, engineers, administrators and even the health care system at large — have the same goal. I do love medicine, and being an ID physician is the best part of that. But until we physicians can, collectively, demand a better system — to improve patient care and patient outcomes, to reduce the ballooning costs of health care and to return the humanity to medicine — I fear we will toil like Sisyphus, damned to the same old routine where patients and physicians can never win.

Photos courtesy Erica Kaufman West, MD