Not all physicians wear a stethoscope, even during a pandemic

I’m a dermatologist, so I’m not on the front lines of this pandemic. And thanks to public health measures, I may never be called to work at coronavirus drive-thru testing sites because we are flattening the curve of infections. Nevertheless, my clinic is reserved as a hospital “surge unit,” so I’ve converted to telemedicine to keep caring for patients—it’s easy to forget amidst a pandemic that other diseases persist and worsen if untreated. While many physicians have long petitioned our government to support telemedicine, a pandemic was able to do nearly overnight what years of letters to Congress failed to accomplish. Much of the red tape separating us from patients has been lifted to permit and pay for virtual visits—changes that should be permanent.

However, not every dermatology visit is amenable to video chat or can be summarized in photographs. While most are familiar with less urgent diseases cared for by dermatologists, we are also consulted to help with potentially fatal drug reactions, skin blistering diseases, and rashes in the immunocompromised. Recently, I finished my turn “on call,” which means if a patient in the hospital develops a concerning rash, my inpatient colleagues can call for my advice. I had to go into the hospital to see a very ill patient, and we needed a skin biopsy—you can’t do that via telemedicine or from six feet away. Despite wearing a mask and taking all precautions, I still worried I might bring the virus home.

Mostly I’m able to do my part to keep health care going while safe at home. Despite some technological challenges, I adapted to teledermatology to “see” patients who can’t afford to wait months until my clinic re-opens. Many of my patients take immunosuppressive medications for autoimmune diseases like pemphigus. Though I advise them to isolate, some live alone and are unable to get food or prescription deliveries due to high demand. When they go out, they depend on others, who could be carriers, to wear a mask. Unfortunately, one of my patients spent three weeks on a ventilator, but still didn’t make it—it’s heart-wrenching when a death is not just another number or a news story, but someone you know and cared for.

I now spend some time calling patients who had COVID-19 tests. Rapid communication of positive results can save lives as we counsel patients on how long to isolate, what symptoms to monitor, and when to seek emergency care. I’ve learned a lot from these phone calls. Many are shocked because they had minimal symptoms and are devastated to realize how many others they unknowingly exposed. Some tell me about financial struggles or employers who told them to come to work or be fired. Several lost insurance during this crisis—they tell me they feel helpless and I do too. Others tell me about loved ones in the hospital fighting to stay alive. And some patients I’ve been unable to reach because they’re already in the ICU.

We still have no proven medication for COVID-19, so prevention remains our best strategy. As a dermatologist, I can do my part by de-populating my clinic while still caring for those who need help. I can leverage telemedicine to keep patients from resorting to Emergency Departments, where they’ll add to the workload of frontline workers. And I can pitch in to ensure test results are quickly acted upon to slow the spread of COVID-19. I may not be intubating patients, but I’m certainly willing to lend a virtual hand, and I’ll even dig through the depths of my closet to find my stethoscope if needed.

Cory L. Simpson is a dermatologist.

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