In February, I had my first patient ask about my thoughts on the coronavirus. At that time, I was aware of the coronavirus and cautiously optimistic about the situation. My advice to the patient was to have a healthy level of concern about the virus, given the medical communities limited data on the virus. I instructed the patient on proper handwashing techniques since this is an issue, even for many medical professionals. I told the patient to avoid touching her face, lips, mouth, or eyes as much as possible. This is actually pretty hard for most people to follow in my experience. I educated the patient on face mask use, when it’s appropriate and when it’s not. I also counseled the patient on avoiding unnecessary contact with large groups of people and social gatherings that will have more than 15 people in attendance. Even though we had an extensive discussion, I still wasn’t overly concerned, and I did not want to worsen anxiety in a patient population already prone to anxiety disorders. I certainly wasn’t recommending people buy all the toilet paper at their local stores or stock up on excessive amounts of food.
Things evolved far more rapidly than most people in the medical community predicted. As cases began to rise in my home state, I started to think about what I could do as a psychiatrist to calm people’s anxiety as well as help my colleagues in the emergency department (ED) and medical floors. I first reached out to my leadership teams in the hospital medicine, and psychiatry departments, and offered my services to see patients on the medical floors, or ED if those physicians were infected and could not work. I think we have a responsibility to the people in our community to step up regardless of specialty. I’m fortunate to be treating patients in the area I grew up as a child and have a special bond with this region. Most psychiatrists are trained in medicine, and perfectly capable of treating medical patients should the need arise. I also offered my services as a psychotherapist to treat any medical professional impacted by the virus. With that said, what steps can psychiatrists take right now to help ease the anxiety surrounding the COVID-19 pandemic?
1. We can direct our patients to resources that have accurate information regarding the prevention of infection, and instructions for what to do in the event of suspected infection. I keep the patient handouts that are available on the American Medical Association (AMA) and the Centers for Disease Control (CDC) websites. These are reputable organizations offering the most accurate and updated information. I go over each handout with the patient and answer any questions. One of the first steps to combating anxiety is quality, up to date education. It allows people to accurately assess their level of risk and dispel misconceptions and fear-mongering. In addition, I tell my patients to reduce their consumption of news media and social media regarding the virus. These are major sources of anxiety for most people and a simple thing you can do to reduce your anxiety immediately.
2. Take the necessary precautions. The CDC and AMA have accurate up to date instructions on how to protect yourself from infection. Follow the resources and guidelines. Have a healthy level of anxiety, and take things seriously, but do not let it consume your life.
3. Instruct patients to remain on medications during this difficult period. There is some talk that patients taking angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers could be at potentially higher risk. This has not been proven at this point and is still under investigation. There is no recommendation at this time to discontinue these medications. However, this point should be extended to all medications, including psychotropics. There is no reason to risk clinical decompensation, and for many people, medications help them maintain their health.
4. Move all nonessential appointments to a telehealth-based service. Most hospital systems now have telemedicine capabilities, and this is a great way to continue to see your patients, while minimizing their risk of exposure. Some patients may be in crisis and need to come in for in-person evaluation, but for your stable patients, use either a telemedicine platform or even phone call follow up in place of in-person visits. If you do any group-based therapy sessions, these sessions should be conducted remotely if possible, or suspended until further notice. I am doing psychotherapy on a telemedicine platform for both patients and physicians impacted by the virus.
5. Focus on lifestyle medicine and interventions. People in high-risk categories such as diabetes are instructed to maintain good blood sugar control, exercise regularly, and eat a healthy diet rich in fruits in vegetables. This is good advice for all patients, while I do not believe healthy diet and exercise alone will protect you from COVID-19, this is an excellent opportunity to develop the habits of lifestyle modification and carry them forward in the future.
Finally, my main objective as a psychiatrist during the pandemic is to ease the patient’s and caregiver’s anxiety. Whether this is through education, psychotherapy, or even just empathetically listening to our patient’s anxiety, we are the frontline defense against this pandemic. We all need to step up in this time of crisis and do our part to make this situation a little more tolerable for everyone involved.
Garrett Rossi is a psychiatrist and can be reached at Shrinks in Sneakers.
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