Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Extending lessons learned to a post pandemic world

Josh Budhu, MD
Physician
June 12, 2020
Share
Tweet
Share

Since COVID-19, the way that we practice medicine has changed. Every patient we see, test we order, and treatment we prescribe is under closer scrutiny. Direct patient interaction has been cut to the bare minimum. This has proved to be a challenge in many ways, forcing us to adapt to a new model of medicine. Counterintuitively, this model may lead to better training, utilization of testing, and increased access to care. While it has been difficult to completely change our practice during my last year in neurology residency, I have firsthand seen these positive changes that can potentially lead to improved training and patient care once the pandemic is over.

As a neurologist, I often order multiple brain and spine CTs, MRIs, and PET scans daily. However, we are now working in a resource-limited environment, and the stakes for imaging and testing have become much higher. One CT or MRI scan opens up nurses, transport staff, radiology technicians, radiologists, and environmental services to potential exposure. Likewise, the patient is also exposed. All the equipment needs to be decontaminated, which sometimes can mean hours before the scanners are operational again, delaying care for others. This has required me to practice medicine without the safety net of having additional testing. It has been a return to the fundamentals of medicine, with increased emphasis on the history and physical examination to guide diagnosis and treatment. Now, I am doubly conscious about ordering potentially unnecessary laboratory testing or imaging, which is a dangerous practice in itself. Unexpected incidental findings occur in as much as 10% of patients. For a large percentage of patients, these findings are benign but cause unnecessary, worry, stress, and further testing. While this has required us to prioritize and triage testing, this higher threshold will ultimately help to address and lower these incidentalomas.

COVID-19 is also shifting our normal inpatient model of care to an outpatient model. Normally we would admit patients to the hospital for transient ischemic attacks or small strokes. Now, as we are consciously minimizing exposure for our patients, we are sending them home with expedited outpatient workup and follow up. Other institutions have recently implemented these measures before COVID-19, without any significant decline in care. It was previously harder to expedite rapid follow up because of physical limitations and time constraints. Now those obstacles are easier to overcome with virtual visits. While virtual visits cannot fully replace in-person interactions, they are helping to increase access to care. Certain specialists, such as neurologists, are in limited supply in the United States. However, there are certain areas with clusters of specialists, especially in cities with large academic medical centers. This disparate proportion of specialists ultimately contributes to health inequities, especially in poorer urban or rural communities. Even where I practice in Boston, patients with limited means often miss appointments because of lack of transportation or inconvenient scheduling. It can also take up to three months to schedule an initial visit with our neurology clinic. As many providers have switched to a virtual format, the availability of appointments has increased dramatically. I was able to see one of my patients on a Sunday evening via a virtual visit because it worked better for both of our schedules. Previous virtual visits before the pandemic usually required some type of computer or expensive equipment. Now, as care has expanded, and technology has been streamlined, patients can use their cellphones for these visits. Continuing to expand virtual visits after COVID-19 can immeasurably help provide better access to care.

COVID-19 has meant many things for the health care system. However, not all of them have to be detrimental. There are lessons and silver linings to take away. As a resident, I have been reminded of the importance of history taking and a good physical examination. It has forced me to hone my clinical skills and think critically about ordering further tests or treatments. For our profession, it has made us adapt to a more outpatient and virtual model. While we may lose some of the personal interaction of a face to face visit, this is mitigated by the improved access to care for all. As we return to a state of normalcy, we should not be so quick to revert back to our old models, but rather we should integrate some of the new adaptations we have made.

Josh Budhu is a neurology resident and can be reached on Twitter @joshuabudhu.

Image credit: Shutterstock.com

Prev

The black physician's burden

June 12, 2020 Kevin 2
…
Next

Immigrant and minority physicians at the frontline of pandemics [PODCAST]

June 12, 2020 Kevin 0
…

Tagged as: COVID, Infectious Disease

Post navigation

< Previous Post
The black physician's burden
Next Post >
Immigrant and minority physicians at the frontline of pandemics [PODCAST]

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Josh Budhu, MD

  • COVID-19 is a grim reminder of my roots

    Josh Budhu, MD

Related Posts

  • The lessons learned from street medicine

    Nicholas Bascou
  • Lessons learned from my MPH gap year

    Waqas Haque
  • How the COVID-19 pandemic highlights the need for social media training in medical education 

    Oscar Chen, Sera Choi, and Clara Seong
  • Why this physician marched during a pandemic

    Raj Sundar, MD
  • The pandemic has only further strengthened my passion to become a physician

    Karan Patel
  • What I learned after being hacked on social media [PODCAST]

    The Podcast by KevinMD

More in Physician

  • Why some doctors age gracefully—and others grow bitter

    Patrick Hudson, MD
  • The hidden incentives driving frivolous malpractice lawsuits

    Howard Smith, MD
  • Mastering medical presentations: Elevating your impact

    Harvey Castro, MD, MBA
  • Marketing as a clinician isn’t about selling. It’s about trust.

    Kara Pepper, MD
  • How doctors took back control from hospital executives

    Gene Uzawa Dorio, MD
  • How art and science fueled one woman’s path to medicine

    Amy Avakian, MD
  • Most Popular

  • Past Week

    • Why flashy AI tools won’t fix health care without real infrastructure

      David Carmouche, MD | Tech
    • Key strategies for smooth EHR transitions in health care

      Sandra Johnson | Tech
    • 2 hours to decide my future: How the SOAP residency match traps future doctors

      Nicolette V. S. Sewall, MD, MPH | Education
    • Reassessing the impact of CDC’s opioid guidelines on chronic pain care [PODCAST]

      The Podcast by KevinMD | Podcast
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • “Think twice, heal once”: Why medical decision-making needs a second opinion from your slower brain (and AI)

      Harvey Castro, MD, MBA | Tech
  • Recent Posts

    • Why some doctors age gracefully—and others grow bitter

      Patrick Hudson, MD | Physician
    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • What the research really says about infrared saunas

      Khushali Jhaveri, MD | Conditions
    • How the cycle of rage is affecting physicians—and how to break free

      Alexandra M.P. Brito, MD and Jennifer L. Hartwell, MD | Conditions
    • Why ADHD in adults is often missed—and why it matters [PODCAST]

      The Podcast by KevinMD | Podcast
    • Dedicated hypermobility clinics can transform patient care

      Katharina Schwan, MPH | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why flashy AI tools won’t fix health care without real infrastructure

      David Carmouche, MD | Tech
    • Key strategies for smooth EHR transitions in health care

      Sandra Johnson | Tech
    • 2 hours to decide my future: How the SOAP residency match traps future doctors

      Nicolette V. S. Sewall, MD, MPH | Education
    • Reassessing the impact of CDC’s opioid guidelines on chronic pain care [PODCAST]

      The Podcast by KevinMD | Podcast
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • “Think twice, heal once”: Why medical decision-making needs a second opinion from your slower brain (and AI)

      Harvey Castro, MD, MBA | Tech
  • Recent Posts

    • Why some doctors age gracefully—and others grow bitter

      Patrick Hudson, MD | Physician
    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • What the research really says about infrared saunas

      Khushali Jhaveri, MD | Conditions
    • How the cycle of rage is affecting physicians—and how to break free

      Alexandra M.P. Brito, MD and Jennifer L. Hartwell, MD | Conditions
    • Why ADHD in adults is often missed—and why it matters [PODCAST]

      The Podcast by KevinMD | Podcast
    • Dedicated hypermobility clinics can transform patient care

      Katharina Schwan, MPH | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...