When COVID-19 becomes blinding to other conditions

The coronavirus pandemic has incited the necessary fear amongst the public and health care workers. This fear is a positive driver of social distancing and other precautionary measures that assist in protecting health care workers and patients. However, when this fear becomes blinding, patients may be more harmed than they are helped. Last week, I had a patient with a likely stroke refuse to go to the hospital due to the fear of coronavirus. The week before, a patient called our clinic 16 times with worsening chest pain but was too afraid to come in to be evaluated. Today, my father with metastatic lung cancer had abrupt onset left-sided chest pain, shortness of breath, elevated pulse and hypoxia, and was told by his oncologist that no other evaluation could be done until he had a coronavirus test.

At the time of this phone call, my dad had been isolated for five weeks. In addition, his oncologist was not able to advise as to how he could actually get the testing or how long it might take for results to return. This left my father helpless in this coronavirus-centric system, which seems to disregard other common life-threatening diseases. Were we not in the time of a pandemic, this same wise physician might have considered a pulmonary embolus or bacterial pneumonia or pneumothorax on the differential and would have advised the emergency department immediately. Instead, my father progressively worsened at home and, at my (his physician daughter) urging, sought the guidance of his primary care physician who worked on arranging the needed testing.

While we need to fear coronavirus, we must still provide the appropriate care for patients with other conditions, especially those that are potentially life-threatening. We cannot bias ourselves with fear. It is not “coronavirus until proven otherwise,” it’s a thoughtful triage of a sick human being, whom you might test for coronavirus in your evaluation. When our fear becomes overwhelming, our short windows of intervention for other health conditions fade and disappear. When patients refuse to seek care, or we advise patients to avoid care without triaging appropriately and thoughtfully, we lose patients to conditions that are treatable. These patients won’t be accounted for by the coronavirus death toll, but in a way, they should. They are, after all, a byproduct of the virus.

To my physician colleagues, act not in fear but in service to our patients. This is not a time to forego the thought processes that are core to our profession, such as building a differential diagnosis or doing a risk/benefit analysis with a patient. We’ve trained for this. We cannot let fear be blinding.

Amber Deptola is an internal medicine physician.

Image credit: Shutterstock.com

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