By Brad Roberts, MD
Emergency medicine physician
PCMS representative on the CMS Board of Directors
Recently I was asked to speak as a panelist during a Colorado Medical Society webinar on smoking and COVID-19. As part of the preparation I read lay news articles from outlets such as Yahoo News, VICE, CNN, and other online sources found through a Google search. I also read multiple articles from peer reviewed journals from a PubMed search.
My biggest takeaway surprised me: It became very clear that as physicians we need to make sure we are looking at true peer reviewed research and look at it with the critical eye we were taught to use at journal clubs during residency. While physicians must understand what the public is seeing, we need to be able to see through much of the popular press and be able to have an understanding of what is true evidence-based medicine compared with what is written as a quick article to entice readership.
Ultimately the peer reviewed studies suggested that more research was needed to further look into why there were possibly fewer smokers admitted to certain hospitals than would have been expected. The researchers acknowledged small sample sizes and confounders that may be present, suggesting only an interesting finding that may benefit from further research. They were careful to state that patients should still be encouraged to stop smoking. The popular press, however, took this to state smoking was protective from COVID-19, which was not what the researchers had even implied.
It also was clear from my reading of the peer reviewed research that smokers with COVID-19 were 2.4 times more likely to go to the ICU, be intubated, or die with complications from COVID-19 than non-smokers. Clearly, now more than ever, patients should be encouraged to make healthy lifestyle choices such as stopping smoking. Implying smoking was protective from COVID-19 was not only premature and likely incorrect but also harmful. Smoking is the leading cause of preventable death in the U.S. and the world and causes far more morbidity and mortality than COVID-19. I have seen these same misleading popular press articles in the cannabis discussion as well.
It is imperative that we as physicians are able to understand and interpret scientific literature through the appropriate lens of the education we were able to receive.
By Vinh Chung, MD, Dermatologist/Mohs Surgeon, Colorado Springs
The patient-doctor relationship has been ingrained through our long medical training and remains at the center of our decisions in daily practice. Based upon trust, this relationship demands that we make decisions that are always in the best interest of the patient. The coronavirus pandemic has brought to the forefront another type of critical relationship – the staff-doctor relationship. While antagonistic staff-doctor relationships are notoriously common and can drive physicians to burnout, they do not have to be this way. When healthy, the doctor’s relationship with staff can be an incredible source of pride and joy.
After executive orders suddenly limited medical services and procedures, the revenues of our medical practice dipped by 90 percent. This unsustainable situation had no end in sight. The cash reserves in our practice were bleeding out and would be depleted if changes were not made immediately. Even before any federal loans or financial assistance became available, our leadership team took action.
We committed to follow our motto that “leaders eat last.” Financial setbacks are scary for everyone, but we recognized that our hourly employees have it much worse. They need their paychecks to buy groceries and to pay rent, so we committed to protect them. Starting from the top down, our executive team took an 80-100 percent cut in our salaries. The rest of the medical providers also voluntarily took significant pay cuts. After we announced our decision, other staff members stepped up and followed suit. Our managers asked to “work more and get paid less.” Some staff members even volunteered to work for free. Across our medical practice, team members who earned the most sacrificed in order to protect those who earned the least.
Watching our team members care for each other is an incredibly beautiful moment that I’ll never forget. I’ve always been proud of our staff because of their excellent work. This time I’ve been humbled by their character. Generosity, selflessness, and the desire to protect one another flourished and became so much more contagious than fear or self-preservation.
Our practice has since received the Medicare stimulus payment and funding from the Paycheck Protection Program, which will buy us more time as we ride out the pandemic. While we had to accelerate departures for team members who were already transitioning out, we have not had to lay anyone off. Two-thirds of our tribe volunteered to furlough, cut pay or reduce hours. There are glimpses of light at the end of the tunnel, and we really do believe we can make it through this crisis with our entire team intact. When we make it to the other side, we plan to restore everyone’s pay and hours in the reverse order from bottom to top. The leaders will eat last.
Similar to the patient-doctor relationship, the physician’s relationship with staff is based upon trust that must be earned. When trust is absent, any relationship can become a thorn in our side or an obstacle we must work around. These unhealthy relationships with staff and administrators are often the root cause of physician burnout. They must be addressed if physicians want to have fulfilling careers.
There is no better way to earn trust than to walk with our staff through a crisis. When our staff know that we are willing to protect them, they will do the same for us. And I believe wholeheartedly that in the long run, our patients will be better cared for as a result.
Vinh Chung, MD, works for Vanguard Skin Specialists in Colorado Springs, Colo. He has a passion for instilling meaning and purpose into the workplace. He can be reached at firstname.lastname@example.org.
The following poem is offered for inspiration during the COVID-19 pandemic.
Author: Monica Anita Gupta
The sun is rising with each shivering step I take.
It’s still dark out, but I see pink creeping into the blue:
spring pastels to match the canary yellow gowns inside.
Cotton candy dreams. A veneer of peace.
A flock of birds welcomes it in, nibbling,
eager for a taste of life,
thirsty for the warmth of sun.
Show me how you fly, you birds.
How, on little nibbles, you get by,
consuming little, yet soaring
long and wide and far and singing,
enthused about the dawn you’re bringing,
with faith in the power of the morning sun.
The poem below was shared with a PCMS physician whose friend, a critical care physician, has posted it in his intensive care unit. It is titled “When this is over.”
“When this is over, may we never again take for granted:
A handshake with a stranger, full shelves at the store, conversations with neighbours, a crowded theatre …
Friday night out, the taste of communion, a routine checkup, the school rush each morning …
Coffee with a friend, the stadium roaring, each deep breath …
A boring Tuesday, Life itself.
When this ends, may we find that we have become more like the people we wanted to be …
we were called to be …
we hoped to be and may we stay that way …
better for each other because of the worst.”
We are grateful to our colleagues who serve on the front lines of the global COVID-19 crisis or work in hospital settings. We value your personal sacrifices and want to do our part to support you and this community.
We commit to doing everything we can to keep patients out of the hospital and urgent care facilities:
- We remain open for urgent, acute, or highly symptomatic dermatology and plastic surgery conditions, e.g., skin cancers with high morbidity or metastatic potential, rapidly spreading rashes, and any conditions that may be urgently concerning to another medical provider.*
- We will serve as a resource to you for any dermatologic or plastic surgery consultations. Our physician team will be available 24x7 (personal emails and cell phone numbers below) for phone consultations.
- We provide telehealth consultations for all patients who need an evaluation, so that patients can remain at home.
- We are happy to assist if you are interested in setting up telehealth.
Most importantly, we want you to know that you are not alone. Please let us know if there is any other way we can serve you and your patients. Email email@example.com to be connected directly to me.
Vanguard Skin Specialists
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