Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.
Featured topic and speakers
AMA Chief Experience Officer Todd Unger speaks with Thomas Sullivan, MD, chief privacy officer and chief strategy officer of DrFirst.com, Michael Carius, MD, ER physician of Bridgeport Hospital and Dan Morhaim, MD, ER physician, author and former legislator on updates regarding COVID-19 including how senior physicians are contributing their experience and expertise during the COVID-19 pandemic.
Learn more at the AMA COVID-19 resource center.
Transcript
Unger: Hello, this is the American Medical Association's COVID-19 update. Today we're discussing how senior physicians are contributing their experience and expertise in unique ways during this pandemic. I'm joined today by Dr. Michael Carius, a staff emergency physician at Bridgeport Hospital in Bridgeport, Connecticut, Dr. Thomas Sullivan, a cardiologist and now chief privacy officer and chief strategy officer at doctorfirst.com, and Dr. Dan Morhaim, an ER physician, author and former member of the Maryland state legislature in Baltimore. I'm Todd Unger, AMA's chief experience officer in Chicago.
We know senior physicians are at a higher risk of serious complications from COVID-19 because of their age. Dr. Carius, you were given the option to be reassigned and yet chose to stay in the emergency room on the frontlines treating COVID-19 patients. Was that a difficult decision for you, and what factors did you consider when you were making it?
Dr. Carius: Well, it really was not a difficult decision at all, although my wife and I discussed it extensively. As an older physician, I have the luxury of being less afraid of the consequences of infectious diseases. My career is nearly all behind me at this point in time. And I also believe that viruses are ubiquitous and that it's only a matter of time before we are all going to end up getting whatever viruses are out there. So I really enjoy taking care of patients, and I think that that joy really comes across when I take care of them. And I think that that's my real role, is to soothe them and to try to make it easier for them to go through the suffering they're going through. So, it wasn't that difficult a decision at all.
Dr. Morhaim: So I'm doing backup for the home monitoring system in the hospital entity that I belong to, but the things that I'm promoting through different kinds of media is that people should be prepared when they come to the emergency room. And this applies pre-COVID, post-COVID. Bring a list of your medical conditions, the medicines you're on, a copy of your EKG, copy of recent lab and imaging tests, and most importantly, complete an advanced directive. Because especially now at the hospital I'm affiliated with, families are not at the bedside. So who do we communicate with? What's the advanced care plan that people have?
And this applies all the time. Every ER doctor knows that we spend too much time trying to figure out the background of the patient. So I actually have prepared for myself five sheets of paper, each one of those things on it. And if I have to rush to the hospital as a patient, I'll hand it to the ER doctor and then they'll know not only about me, but who to contact if they need to, because there's no families at the bedside. And I'm working very hard to promote that in my region, and I hope everybody will do that.
Unger: Dr. Sullivan, how have you adapted your role to meet the needs of the pandemic?
Dr. Sullivan: So I practiced, saw patients for about 45 years as a cardiologist. And then I went part-time with a software company that is physician-oriented, actually located in Rockville, Maryland. When the pandemic came, I was asked to help educate our employees, staff, which we have all around the country, mostly at Maryland and Arizona. And I wrote some blogs on showing how they could get reliable, trustworthy information from the internet, from an actual member of the American Medical Association, as well as the Massachusetts Medical Society. Between the two of us, JAMA and the New England Journal of Medicine, which are really great resources. So I put hyperlinks to those, to the actual COVID-19 pages and got a lot of good feedback. We're located right next to one of Johns Hopkins affiliates. So I was able to direct our staff to the CDC guidelines and the Academic Medical Center guidelines for staying safe, and what's the latest medications and potential on vaccine.
Unger: I'm curious about your advice to other senior physicians who are looking to get involved, whether it's returning to patient care or other roles. Dr. Carius, why don't you start?
Dr. Carius: Well, there are certainly challenges and rewards. The challenges would include the electronic health care record documentation, which is a moveable feast. And if you've been away from it for any period of time, you would have to go back and be completely re-indoctrinated into that.
The second is that there's much more emphasis on infection control today than there ever has been before, much more than simple hand washing. So the rewards are taking time with patients, to be able to actually sit down and go over the patients, whatever is happening. People don't understand it, but almost half the census around the country in emergency departments has gone. So emergency departments are not crowded today at all, which gives us more time to spend with those people who are really sick. And most of the people coming to the hospital today really are sick.
And in fact, those who are found to be COVID positive, if they are symptomatic enough, end up being admitted. But those who are also sick without the COVID test also end up in the emergency department, waiting until their COVID test comes back before they can go upstairs to either the operating room or to the inpatient ward. So we really take care of patients now for an extended period of time, even though we're not taking care of nearly as many patients.
Dr. Morhaim: I would say there's lots of opportunities for physicians to be involved in any number of different ways, from policy advocacy to hands-on clinical care and everything in between. But the other point that I want to emphasize is that COVID is also highlighted to me, at any rate, a lot of the shortfalls in our system that existed before but are highlighted now.
I chair our county's behavioral health care council, which is required in Maryland, in every county. And so there's a lot of stress at home, a lot of substance abuse, more alcoholism potential, a lot of social disruption, health care disparities, significant issue and certainly health care disparities in COVID. All these things existed pre-COVID, but COVID has highlighted some of the real serious shortfalls. And now when compounded with unemployment and other economic calamities potentially coming and being worse, we really have to be prepared for that as well. I think there's always a role for physicians to participate in all of those.
Dr. Sullivan: And if I could add to the previous statement, behavioral health is uniquely adaptable to the telehealth and telemedicine. One of the things that I've been doing is helping develop the telehealth applications within our own company and sending them out to hospitals and doctors, especially small practices around the country. For instance, in behavioral health, it's uncommon for the psychiatrist to have to do a physical exam, but the fact that you can do a video and see the person face-to-face remotely emphasizes the safety of this, and you want to be able to see the reactions when the patient talks to you and you talk to them, back and forth. So it's an interesting application where I think telehealth and telemedicine is here to stay, especially now that the reimbursement regulations have been relaxed to some extent.
Dr. Morhaim: I think also there's—I work with a company that does home monitoring. So we have people at home, and we have algorithms that monitor that, so they can measure their pulse ox, their blood glucose, their temperature. It all goes into a smartphone app. And that can be applied in the future for congestive heart failure, for all kinds of conditions. People can do their home FEV1s. And so I think telehealth is part of it. And I think there's other things that we can gain. There's lots of stuff that's going on that is maybe dramatically worse, but then there's maybe new tools coming that will help manage some them.
Unger: Last question. What advice do you have for young physicians who are experiencing the pandemic earlier in their careers and probably have not seen this level of things like death and weren't expecting that?
Dr. Carius: Well, I would say three things. One is to certainly take the pandemic seriously and take the appropriate precautions. Secondly, make sure that your family is on board with the consequences of infections. And if they're not, to find ways to get them away so that you're not going to feel guilty about bringing something home. And the third thing is to never lose sight of your humanity.
Dr. Sullivan: One of the things that senior physicians have is so much experience, and we can help teach the younger doctors, once again, as you implied, about what we've done. We've all gone through the AIDS epidemic when no one knew exactly what it was and how it was transmitted. And then over the years, I mean, there was a lot of fear, tremendous fear and anxiety among both patients and physicians. And we as seniors all remember that and how we worked through it and how the advances in science helped identify the culprit and ultimately came up with the antiviral treatments. It's just a terrific—and I have to say, we've never seen anybody like Dr. Fauci who has become a real hero, and Dr. Birx and some of the other doctors around the country. That's something where we can show the value of physicians and their education. And I love teaching.
Unger: Dr. Morhaim, any advice from you?
Dr. Morhaim: Very quickly, despite all the stresses and problems and anxieties and difficulties that go along with it, it's a great job. It's a great profession. Stay with it, it's really worth it, and focus on what Michael emphasized, the humanity and the personal aspects of this. So when you take away all the billing and malpractice and all that other stuff, it's still a wonderful one-on-one opportunity to help people. And there's nothing quite like it. And it's wonderful.
Dr. Sullivan: Well said.
Unger: Well, thank you so much, Dr. Carius, Dr. Sullivan and Dr. Morhaim for being here today and sharing your perspectives. That's it for today's COVID-19 update. We'll be back tomorrow with another segment.
The AMA has resources for senior physicians who are looking to contribute during the pandemic. Our senior physicians COVID-19 resource guides covers license considerations, professional liabilities and a wealth of information for getting involved in nonclinical roles. This and other updated resources on COVID-19 can be found at our website, ama-assn.org/COVID-19.
Thanks for being with us here today.
Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
