Two Philly doctors on how coronavirus is changing their practices, their lives

We are two physicians, providing care in very different places—primary care office practice, and inpatient cardiothoracic surgery. We reach out to each other and share how medical practice in our respective specialties has vastly changed in a matter of weeks, to a point bearing little resemblance to what we are used to. We compare, contrast and learn how we are each adapting in our roles. Our separate worlds have contracted, yet we widen our perspectives through shared experiences.

The first thing that strikes me is the vacant parking lot. Even at 6:45 a.m. on a typical day, our office lot is speckled with parked cars and delivery trucks. Today it looks and feels more like a weekend day, like I am making an unplanned trip to the office to retrieve something I left behind.

I detour to the rear of our building so I can enter through the door where our staff waits to take my temperature: 98.5. I’m cleared to proceed to my office, which sits across from a row of exam rooms. When I arrive, one exam room door is usually closed, signaling that my medical assistant is preparing my first patient for their visit. Today, both of my rooms have open doors, and are dark inside. Vacant. The hallways, usually filled with staffers preparing rooms and stocking supplies, are empty and silent.

I log on to my office computer, which is where my practice lives now, and for the foreseeable future. We have adapted our workflow, from check-in through medication review, preventive health screening, and then my visit—to an almost all virtual process. On the rare occasion when an actual patient comes in with something which requires direct examination, it feels like awakening from a surreal dream. I savor the encounter, uncertain when the next one will be.

Connections with patients are difficult to nurture right now, and connections with colleagues are even more challenged. Along the clinicians’ office corridor, doors which we used to stroll in and out of for consultations or just to say hello, are all closed, as we each carry on behind those doors with our virtual practices. We hold staff meetings on the phone too, even though we are all in the same building. Face time still feels so remote.

There is a palpable anxiety beneath the strange quiet. I can feel it when I enter the hospital building each morning after being screened for a fever, and when I walk home each evening across the empty university campus.

Morning rounds, once a social routine with large teams of fellows, residents, medical students and advanced practice providers greeting patients in their rooms, is now brisk and pragmatic. No more than two people are allowed in the room. We now wear masks at all times and stand at a distance from each other and our patients. We refrain from any physical touch.

No one on our team feels ill, but no one knows if they are an asymptomatic carrier. On the rare occasions we aren’t terrified of making someone else sick, we fear being at risk ourselves.

Every hour, our phones light up with emails outlining new alerts and policies. It is difficult to stay up with the pace at which everything is changing. We constantly flip through news about Italy and New York, and wonder if this is the day it begins in Philadelphia.

It’s called the calm before the storm, but it doesn’t feel especially calm. Visitors and students are no longer permitted. All elective operations and office visits have been postponed, meaning anyone who needs treatment, but can survive without it for now, is waiting at home until it is safe again.

We take all of these measures in hopes of ensuring that when patients with CoVID-19 arrive in respiratory distress in unpredictable numbers, we will have enough beds, ventilators, and protective gear. Running out of supplies is something we never had to think about before. We reflect on how much has changed in so little time.

Together

We look to our colleagues for support, wherever they may be. We find camaraderie in social media connections, seek solace in reading and writing. We find common ground in what we all are doing to fight the virus. We write to each other, always replying eagerly. We look for better ways to share information with fellow providers, and also the public.

We feel more proud than ever to be physicians, sources of reason, information and guidance for our patients.

We all need to share our stories, advice, wisdom, understanding, and good wishes. This is about our survival.

Jeffrey Millstein is a primary care physician and medical director for patient experience-regional practices at Penn Medicine. Jason Han is a resident in cardiothoracic surgery in the Perelman School of Medicine at the University of Pennsylvania. Both are frequent Inquirer contributors.