Looking back on the COVID-19 pandemic in the United States, I hope that we are able to take away several lessons.
Immediately after the virus showed up in the United States, many physicians without access to virus testing seemed to go straight to imaging for an answer. While a few imaging tests proved to be useful in the most typical radiologic presentations of the disease, the evidence supporting this specificity or the lack thereof was not clearly evident until testing for the virus was more readily available. In the pediatric population, viral respiratory illnesses are common, and radiology reporting methods commonly refer to viral illnesses in a generic sense of the term. I hope that we learn that imaging is not the automatic answer to every new medical question.
In some areas, access to the swabs needed to collect samples was the limiting factor in implementing testing. For years, both in my prior career in the medical laboratory and in medicine, we were taught the concepts of Lean manufacturing, and COVID-19 exposed the limitation of this approach. In Lean, industries are taught to avoid waste by only keeping enough supplies on hand to meet needs. When emergencies require a massive need, having limited supply chains can be quickly exhausted. This is even more true with personal protective equipment. We need to remember this moving forward.
I don’t know any more about the virus than I did in March, which is frankly a dark day for science. I see these very imprecise projections, nobody knows if prior infection confers immunity, and most of the country is stuck in this purgatory-like state with no answers coming. I have read no explanation as to why vaccine research was not successful for the previous coronavirus-related diseases. Printed scientific journals are just now publishing a slew of minimally relevant disorganized perspectives on COVID-19, yet another reason why classical academic medicine is horribly behind the times. If we have to wait months for a publication cycle to complete, the value of the information becomes stale. Reading science in a journal now is like looking at a star in the sky without realizing that the light coming from it was produced thousands of years ago.
I looked back at podcasts through March, and the tone regarding COVID-19 changed so rapidly. First, economically-minded influencers dismissed the likelihood of shutdowns; and then some of these people panicked when the virus flourished in mid-March. Bloggers like me worked hard to be as optimistic and patriotic as possible, and some stability returned to the economy through governmental subsidy. Now, only three months later, my employer extended travel restrictions, but Memorial Day was, unfortunately, business as usual in many parks and beaches. There is clearly a disconnect. Our approach to limit physical distancing has been relatively half-hearted. I just don’t think that we can convince Americans to act solely for the benefit of the vulnerable. This is troubling news should something like this happen again.
In my department, outpatient imaging tapered sharply, causing significant financial strain. Now, we are in a race to refill imaging appointments, as some centers doing less detailed scans may schedule faster and lower quality MRI techniques. This exposes a problem with our billing system. A bad MRI pays the same as a good MRI. There is no incentive to innovate.
Telehealth has emerged as a viable industry. I worry if this becomes overutilized. It definitely has its place, but it creates an opportunity for people to use this as a profit center when sometimes people need to be seen. I learned that my blood pressure medication refills were being driven by the pharmacy, and when my doctor asked to see me via telehealth to get more refills, I declined. I haven’t needed more refills in over a year, and when I have my annual physical, I want to get an actual physical.
Still, there are some silver linings. Working from home makes me a better radiologist with fewer distractions and much enhanced work-life balance. I was applying for new jobs when COVID-19 hit, but I will stay at my current position if I can continue this. Incidentally, I received about $15,000 in student loan payment relief if my loans are forgiven later this year on schedule.
I also recently did some continuing education via the virtual session of a meeting that had been canceled. I could view more recorded talks, engage in live chats with other viewers, and spend far less money.
The important thing is that we keep learning and try to remain positive. This is something that I will have to remind myself while I put a mask on to enter a boarded-up department store after watching a sporting event with no fans in the stands. Stay well!
Cory Michael is a radiologist.
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