This physician is overwhelmed. She is not alone. [PODCAST]

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“I am overwhelmed right now. I know I am not alone. I hear it in the voices of my friends, family, colleagues, patients. We are all feeling it.

I am overwhelmed by this virus. There is so much to learn, so much to teach. Every day the information changes. Who is credible? Who is just shouting the loudest? It can be hard to sort, but it must be done. As I figure it out, I need to pass on the information in the most compassionate but clearest way possible, despite the naysayers.

I am overwhelmed by our numbers. In my small county of about 40,000, we had two cases on March 22, ten on April 1, seventeen on May 1. We seemed to be doing ok. Then we climbed from 76 on June 1 to 196 on July 1. And as of July 8, we are up to 346. That’s 150 in a week. That more in one week than we had in 3 months. And it is not just from testing more. Our hospital, COVID-free for weeks, is now seeing more and more COVID-19 patients not only in the ER but needing admission and serious treatment. The numbers are heart-stopping.”

Diana R. Twiggs is a family physician and can be reached at her self-titled site, Diana Twiggs, MD.

She shares her story and discusses her KevinMD article, “I am overwhelmed right now. I know I am not alone.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Diana Twiggs. She is a family physician, and she wrote the KevinMD article “I am overwhelmed right now. I know I am not alone.” Diana, welcome to the show.

Diana R. Twiggs: Thank you for having me. This is exciting to be here.

Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and your journey to where you are today?

Diana R. Twiggs: Sure. I grew up in Florida. I’m in a non-medical family, and I really wasn’t sure what I wanted to do. So I ended up going to school at Florida State because I wanted a big school; I wanted whatever it was to be there. I started college life as a math major, and I tried, I thought about music and English, and I ended up really being drawn to medicine.

Shortly, actually right after graduating, I got married and did medical school at University of Florida. During that time, trying to decide what to do with my life, I ended up really loving family medicine, just because of the variety. I wanted to be able to take care of the whole person, the whole family, and not just one specific organ, which I couldn’t see keeping me interested through my whole life.

So I went into family medicine, and after a brief stint in South Carolina, I have been back here in Florida, and I’ve been in this same building for over 20 years, but with different iterations of the practice. I actually joined my father-in-law in practice, then ended up becoming the practice owner, and now I’m an employed physician in the same building. So I’m doing just general primary care, but I’m also very involved in organized medicine, particularly, mostly at the state level. We live here, and I’ve raised a family here.

Kevin Pho: Tell me what you’re seeing from your view during the pandemic, and especially from an organized standpoint, what kind of initiatives are you advocating for on behalf of physicians as it relates to the pandemic?

Diana R. Twiggs: Well, one of the things that I was immediately excited about was how, in one day, all of a sudden, the barriers to telemedicine went away. We had the technology, but just suddenly, “Hey, you guys can do this, and guess what, we’ll pay you for it fairly.” So that’s been, I think, to me, one of the big practice pluses from all this, in a world of a lot of minuses. I’m seeing a lot of patients really taking to that. It’s not for everybody, but a lot of patients are extremely appreciative to have that availability and that technology.

As far as what I’m seeing in the office, just a lot of the usuals, but just a lot of real fear out there: Where are we, and what’s going to happen? Where are we going? A lot of mental health issues, which is a norm in family medicine. We have such a shortage of mental health professionals that a lot of that ends up falling on us.

Kevin Pho: We are now speaking towards the end of December, and a vaccine, two of them now, are rolling out. Now, are we seeing a lot of trepidation for the vaccine when patients ask you about them?

Diana R. Twiggs: A little. Mostly, my patients are very excited about it. A lot of my elderly patients have said, “Please sign me up. I’m ready to get it.” So unfortunately, I don’t have that yet, but most of them are very ready. I’ve had a few people with some questions about it. Most of the questions, I think, come from disinformation on the vaccines themselves that have so far been approved, but I’d say overwhelmingly, people are excited to get it.

Kevin Pho: All right, let’s transition now into your KevinMD article, “I am overwhelmed right now. I know I am not alone.” Now, for those who haven’t read the article, can you just walk my audience through it and maybe share the story of why you decided to write it?

Diana R. Twiggs: Sure. I start most of my mornings with a run, and I’m often listening to podcasts and news stories. That’s just my time to try to catch up on everything. I wrote this article in July, after having four months of just feeling like I was drinking from a fire hose. I was still trying to process everything between medical news and world news, and I was trying to get everything in and figure out where I needed to be and what I needed to be telling people. That one particular morning, it was just on the news, tragedy after tragedy, and I just started feeling like this is too much.

The more I really thought about it, I thought, “You know, I’m not the only one feeling like this. Everybody’s feeling overwhelmed by this pandemic, by quarantine.” But then, when I kind of looked around, I thought, “But what wonderful things are people also doing?” I’m seeing things in my community that were just full of neighborly love and really caring for each other. There were these two good and bad sides just pulling so much, and I thought, “This is just a lot of emotion that I don’t think I’m alone in feeling.”

I started it as sort of a blog back in March, when I realized we’re at a unique moment in history. I was just writing in my journal what I think about this; maybe people want to hear what I’m going through and what I have to say, what my experience is in a family medicine office. So I started doing that, and that particular podcast just came to me on a run, as a lot of them do, when I thought, “This is so much. I just want to express to everybody that you’re probably feeling this, and so am I, and let’s just keep taking care of each other.”

Kevin Pho: Now, what were some of the specific thoughts and feelings that you were going through as you were writing that, and what are some of the techniques that you use to help get you through that?

Diana R. Twiggs: Well, one of the stories that morning had to do with a young Black man, who was a boy, who was jumped for no reason whatsoever other than his race. I just thought the amount of hate in that was overwhelming to me. On the same page, and I put that in the article, was the story of a man in our community who we all literally thought had probably died. He was coming back from a long-term care situation, and he had nothing, and just seeing the community come together to bring him the physical things he needed and really support him. I thought, you know, on the one hand, and also, just by the way, he was a Black man, and I thought, “You know, the same communities that are just tearing each other apart, really, I’m seeing the other side, where people are just being so compassionate towards each other and helping each other,” and people bringing groceries to their asthmatic neighbor and their elderly.

So I wrote it just thinking, what things are coming into my world that I’m needing to process? Not just the information, but, I love to travel, and I’ve been at home for, you know, not in the office, but I have not been anywhere in the longest time. It feels a little bit selfish to say, “Gosh, I just want to get out of here and go do something,” but that’s just a little part of all these little things we’re all feeling. So in a way, it was sort of a vent for me, to just say, “Here’s a little bit of myself,” and I’m just going to be vulnerable and say what I’m feeling.

Kevin Pho: Now, you wrote that, I believe, in the summer, and we’re speaking about six months later, and we’re in the midst of the latest wave of the pandemic. Some say it will get worse before the vaccines start to take hold and get better. Now, has anything changed since then, and what are some of the challenges right now that you’re currently facing from, I guess, a mental health standpoint?

Diana R. Twiggs: I think that feeling of, when is this going to end? Even though the vaccine is here, it’s not really here. We’re only in the very beginnings of it, and even those who have the vaccine, we really have to wait to develop that immunity. People seem to have a little bit of hope knowing that there is something, and it’s a big something, but we just have to hang on that little bit longer and just keep taking care of each other and keep taking care of ourselves.

It is so frustrating when you see people not doing that, where one family member is quarantining because of an exposure and the rest of the family says, “Well, you know, I’m fine. I’m going to go out and do my thing.” So that continues to be a challenge, trying to support people to just do the right thing. The end is a little bit in sight. We’re not there, but we can see that it’s almost close.

Kevin Pho: I think there’s a level of exhaustion, certainly among health care professionals. I see it on my blog, I see it on Facebook, and I talk to a lot of clinicians on this podcast who are feeling that exhaustion. Already, before the pandemic, almost half of physicians expressed feeling burned out, and this is only making it worse. Now, what are some pieces of advice that you could share with these health care workers who are on the front lines, who are exhausted, who are burned out? What are some things that you can say to help get them through this?

Diana R. Twiggs: You know, I think before this, I was one that was feeling quite a bit of burnout. Not that that has disappeared, but in a way, I felt a bit energized being in primary care during this pandemic, because I felt like this is what we’re made for. I mean, let’s roll up our sleeves, and here we go. We never knew this would be it, but this is why we do what we do. I think kind of renewing that sense of calling, towards “I’m here to help people,” has helped a little bit, finding new ways to do things and finding new ways to connect with patients.

And really realizing that for some of my patients, whether they’re in person or on telemedicine, I am their only human interaction that day, or maybe for a couple of days. At home, they’ve got their dog, and that is it; they live alone. And maybe taking that extra minute, a couple of minutes, to just listen to them, even if it’s not about their diabetes, and just kind of ask them not just, “How are you doing?” but, “So what kind of dog do you have?” Just little things that they need to maintain that connection with people, and realizing how important the few minutes I have with them can be.

Kevin Pho: That’s great advice. We’re talking to Diana Twiggs. She is a family physician, and she wrote the KevinMD article “I am overwhelmed right now. I know I am not alone.” Diana, if there’s something that you know now that you wish you knew back before the pandemic started, what would that be?

Diana R. Twiggs: Well, I do wish I had known how long this would last. I think early on, we thought, “We’ll hold our breaths for a few minutes.” I think even anybody who’s been through medical training, you know, we’re pretty savvy at delayed gratification, but even then, we had some idea of the process, how long things would take. There was a lot that was very predictable about training and what our lives were going to be doing, and every day seems like an unknown here, where we think things are getting better, and then they get worse, and then they get better, and now they’re worse, and the new non-pandemic-related events come into our lives. So, I think, I wish I knew that this was going to be truly a long haul, and that the hardest part is just really not being able to say, “Well, it’ll end at this particular time.”

Kevin Pho: One of the things that you talked about earlier was, of course, telemedicine and how that impacted primary care. Now, once the pandemic finishes, whenever that may be, how do you envision telemedicine playing a role going forward?

Diana R. Twiggs: Well, I think we can’t go back on it. I think physicians love it, patients love it. Not everybody, but there’s a large section. I, as a patient, love it. I don’t have to drive down to see my primary care physician. I can just, from my office, not have the drive time, but do this exact same format and have my visit. So I think that telemedicine is here to stay.

I truly hope that we can continue with proper reimbursement for it and not have to go back to closing the door on that, because it is every bit as intellectually difficult to have a telemedicine visit with a patient. It’s not nearly easier; it’s possibly harder. I think we need to be fairly reimbursed for that, because it takes the exact same amount of mental capacity and all of our training, and then some, to be able to do a proper telemedicine visit. I’ve been really grateful for those teachers who have been able to tell us, who were not experienced with that, how to really run a proper and useful telemedicine visit, including some physical. I’ve been very surprised how much physical exam can be done by teleconference.

Kevin Pho: Now, from your perspective, being involved with organized medicine, I’m sure you’ve talked to people within government, perhaps some people within the health insurance industry. Now, what’s your sense about their views when it comes to reimbursing telemedicine after the pandemic ends?

Diana R. Twiggs: I think some of it is a feeling of maybe old laws and regulations tying our hands, needing to have not just a balanced budget but the zero gain, where if you bonus one side, you’ve got to cut from another. That’s just not practical. No other industry does that. If we’re growing as an industry, expenses may have to increase. There’s always room for being more efficient and cost cutting, but I think we need to be wise in how we do that.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Diana R. Twiggs: Share yourself with people. You know, it’s OK to be vulnerable. I’ve been surprised at how much people have appreciated hearing my story, and along the way, I really hadn’t expected that kind of feedback. But I think, go ahead and explain to people what’s going on with you. I think just being vulnerable, being able to tell people what your perspective is, and being able to laugh with your patients as well as cry with your patients.

Kevin Pho: Thank you so much for sharing your time and insight, and thanks again for being on the show.

Diana R. Twiggs: Thank you so much.

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