Philly doctor not on the ‘front line’ shares what it’s like to care for patients during pandemic | Expert Opinion

As an outpatient dermatologist, during this pandemic, I’ve continued to see patients in person at my practice. I’m humbled by the sacrifices and dedication of the doctors, nurses, and staff manning the ERs and ICUs who are truly at the front lines, but all of us in health care need to do our part to keep the system afloat.

At the beginning, my care was limited to virtual visits and telemedicine, and COVID-19 test result triage, but now I’ve adapted to seeing patients in person most of the time.

At first, I admit, I was uncomfortable. One of my favorite parts of day-to-day work is getting to know patients, and learn about their lives, far beyond the diseases I treat. I usually ask every patient about their families, children, pets, and jobs, because these details can be relevant to their medical situations, and it gives me a sense of who they are and what their support system looks like. (You wouldn’t believe how many people have turtles as pets!) But when I started seeing patients again during COVID-19, that warm feeling of getting to know you was gone.

When I entered a patient room, I felt like a spy on a retrieval mission: Get in and get out as quickly as possible, an extraction in which my goal was to spend as little face-to-face time to minimize unnecessary exposures. Talking to patients, I tried to put on a happy face (behind my mask), but I felt antsy, always itching for visits to finish. This feeling bothered me because I knew that the quality of the care I was delivering could suffer by cutting time short.

Even though our screening protocols asked all patients about contacts and symptoms to minimize risk, I worried about any contact at all. I didn’t want to bring anything home to my family. A few patients had recovered from COVID-19 and weren’t contagious anymore, but that made the risk feel all the more palpable.

Of course our office had done an impeccable job enforcing protocols. I now wear street clothes to the office, change into scrubs, and then change back before leaving to go home. I never really liked wearing button-down shirts and khakis, anyway, and I can’t say leaving my white coat on the back of my office door bothers me much, either.

I now wear a mask and a face shield at all times when I see patients. I wash my hands and use sanitizer even more compulsively than before. And I’ve become a pro at punching elevator buttons and opening doors deftly with my elbows, with a casualness sure to impress. I’ve embraced the elbow bump as my go-to greeting in lieu of handshakes. We limit patients from having visitors, space out appointment times, and still see as many patients by telemedicine as possible.

Over the last few months, though, I’ve finally become comfortable with the new habits, and my patients seem to be adapting, too, most of the time. Ironically, the only time I can truly be “face-to-face” with my patients, neither of us masked, is over video calls. At least with return patients, if I don’t recognize their masked faces, their voices are familiar, and I get to see their faces for the brief seconds when I remove their masks for the exam.

I imagine that when most people go to the doctor these days, they’ve done a calculation in their heads: Is the minor risk of COVID-19 exposure worth the benefit of seeking a doctor’s care and advice? I get it, but we must continue important preventive care, and I encourage everyone to ask their doctors what their options are: Should you go in person, be examined virtually, or is putting off a visit reasonable or risky?

I constantly ask patients, “How are you doing with all this craziness?” They will often start to answer, “all things considered” or “as good as can be expected.” Several of my patients have lost close family members, parents, siblings to COVID-19. When I ask about people’s work, I’m hearing much more about “not working right now.” We’re in the hardest of times.

This may be the “new normal,” yet the recent vaccine news offers hope and the promise of a return to how things were. In the meantime, I’ll continue doing my best to adapt and find a way to co-exist with this coronavirus, while still giving people the care they need.

Jules Lipoff is an assistant professor of dermatology at the University of Pennsylvania’s Perelman School of Medicine.