COVID-19 Is Infecting Our Clinical Acumen
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and L. Chisick, MD, FRCPC
Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
J Gen Intern Med DOI: 10.1007/s11606-020-05997-7 © Society of General Internal Medicine 2020
in Mr. Smith’s room, with two feet of Y ouspaceareonstanding either side of his hospital bed, trying to get a history from this ill 70-year-old man before you examine him. He’s diaphoretic and appears septic. You see his scalenes working, desperately tugging at his ribcage to keep up with his respiratory effort. His vitals on the bedside display tell you his heart rate is ticking along at 130 beats per minute. His blood pressure is slightly lower than makes you comfortable. He coughs. Suddenly, you are not thinking about the patient anymore. Is your PPE donned appropriately? Should you have worn an N95? Why did not you wear a scrub cap? It’s getting harder for you to breathe under this surgical mask and you are starting to sweat under the gown. He coughs again. You cut the interview short and tell the patient you are going to examine him. You grab the disposable stethoscope in the room and attempt to listen to his heart and lungs, turn his neck a few times, and with a fleeting poke at his abdomen and a peek at his feet, you rush out of the room. You feel relieved to take your PPE off and you proceed with the ritual of scrubbing your hands until they feel raw. The only differential diagnosis that keeps coming to the forefront of your brain is COVID-19. For some reason, none of the other differential diagnoses seems important anymore—at least not until the COVID-19 swab result returns in a few days. The fear surrounding COVID-19 is palpable, and the sense of insecurity and uncertainty has spread farther than the virus itself. At the Health Sciences Centre, the largest tertiary care centre in Manitoba, we spoke with several internal medicine residents and attending physicians at length about the effect of the pandemic on clinical medicine. There was consensus that the COVID-19 pandemic has affected the way in which they practice. The specialty known for its detail-oriented patient care and verbose progress notes seems to have forfeited its meticulous nature. Decreased time spent with patients, deferred in-depth physical examinations, clinic visits over Received May 24, 2020 Accepted June 15, 2020
the phone and a change in clinical acumen are examples of the ways in which medicine has been affected by this public health crisis. In a recent survey conducted by Doctors Manitoba, 53% of physicians said their health and wellness was a top concern, including the potential of contracting COVID-191. To highlight this point, several patient encounter notes now read “physical examination deferred,” with listed reasons including “weighing the risk of exposure versus benefit.” The fear and concern for our own safety, as health care workers, has taken a significant toll on the routine steps of patient interaction. A 2013 cohort study demonstrated that patients placed under routine contact precautions resulted in a 36% drop in
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