Primary care: 2021 in review
Looking back on 2021 as a family physician in an independent practice, I have several thoughts about the impact COVID-19 has had on my patients, staff and practice — what we have seen and learned and the adjustments we had to make.
The rapid onset of the COVID-19 pandemic and the rapid transmission of the illness led to changes within my practice at a pace I had not seen in 30 years. Processes once used only with known infections like tuberculosis and influenza, such as masking and cleaning of rooms, clearly defined handwashing and use of personal protection equipment, are now the norm and an ongoing process with almost every patient.
We changed the way patients are triaged regarding symptoms and when, where and how they need to be seen. How patients present to our offices and rooms has been altered to fit the pandemic and to provide safer and better services to all. Patients are no longer in our waiting room with a large number of others and in close proximity. They wait in their cars and are called as rooms become available for their appointment times, are met at the door and escorted to their rooms, then escorted out when the visit is complete.
Modification of workflows included the rapid deployment of telehealth, which allows for many follow-up appointments and some new concerns to be handled without a face-to-face visit, and even allows for history-taking to occur while patients are still in their cars. This minimizes exposures and risk for staff and other visitors. With the rapid changes in guidelines for screening, testing, vaccinations and proper safety precautions, clinicians have had to read more and study more to be up to date on how to better serve patients as well as to be able to answer questions and dispel misinformation.
As a business, the most obvious effects from the pandemic were the alterations to our processes. However, there was also the demand for rapid changes to meet the needs of staff and patients. We made it through 2020 with significant loss of revenue from patients not coming in early in the pandemic, which made us rethink our business model to streamline staffing, services and processes. We adapted to be able to stay up to date on information and recommendations that often changed daily. We struggled to access and procure needed equipment and goods (gowns, masks, hand sanitizers, etc.) that were essential for our function, but were often in short supply. Changes were needed in our ventilation system to help circulate air faster to decrease transmission risks — things we were never taught in medical school and never thought about previously. We modified the office so that staff, whenever possible, did not share closed spaces. Encouraging and educating staff on the need for and benefit of vaccinations and other safety procedures occurred and continues as a part of our normal training of staff, new and old. These changes occurred through cooperation of staffing and with some help by the larger medical community.
As a family physician interested in the health of my community and who has seen a number of national and local events which stressed and challenged us, this pandemic is the first I have witnessed that, on many levels, has divided people rather than brought us together. When our country was attacked by a foreign visible enemy, we all banded together and accepted alterations of travel and life with minimal complaint. When challenged by an unseen enemy that has now claimed well over 100 times more lives and is still active, we look to blame others and question its severity and validity in all aspects of treatment and prevention, often based along political lines and/or misinformation gathered from unreliable sources. Patients questioning their health care team members and choosing to believe information they saw online or got from a friend is something I had seen rarely in the past, but now is itself a pandemic. I continue to wonder how we can get past this and begin working towards the protection of all and the hopeful resolution of this crisis.
For the future, however, I feel there is great hope. With any crisis comes the opportunity for rapid improvement, adaptation and change. The pandemic has brought significant scientific investigation, cooperation and development of technology at a speed never seen. Vaccinations were developed, marketed and “in arms” at a historic pace. The use of technology such as telehealth exploded, allowing us to serve patients by meeting them in a new way — in essence going to them — and providing good care and a continuity of care with good outcomes and low risks. Point-of-care testing in offices for COVID-19 became rapidly available at reasonable costs and will lead to further development and use for other conditions in our offices. This will broaden our ability to treat current and future conditions early and effectively at the time patients are seen and thus improve compliance and decrease resistance and complications. Cooperation of organizations, cities, states and countries will better prepare us to address and better handle other communicable conditions in the future. Lessons learned will allow individual offices like mine to feel confident to handle other changes with more confidence and less stress.