Dr. Scott Isaacs has worked as an endocrinologist for more than two decades, focused on the medical needs of adults with diabetes in the Atlanta area. He never expected to be serving on the front lines of a pandemic.
For weeks, his phone has been ringing off the hook. His diabetes patients, a high-risk group for coronavirus infection, want to know: How can they get tested? How can they stockpile extra medication? And can he write to their employers to recommend they work from home?
Last week, Dr. Isaacs saw a patient with Type 1 diabetes, a nurse who is 10 weeks pregnant. She asked him how long she should stay home from work to avoid possible exposure, and he had to respond honestly: “I really don’t have an answer to that.”
Dr. Isaacs is used to relying on his medical expertise, but the coronavirus has suddenly put him in new territory, an experience shared by many medical specialists who may serve as the primary physicians of patients with particular medical needs. Physicians across every field who are trained to care for very specific medical problems are confronting a surge of patient questions and scrambling to keep up with rapid changes in case numbers and advisories from governments and health agencies.
“We’re hearing a lot of anxieties from specialists who don’t know what the right thing to do is for their patients,” said Dr. Megan Ranney, an emergency physician in Rhode Island. “Dermatologists, ophthalmologists, we’re even hearing from dentists.”
Dr. Sandra Weber, president of the American Association of Clinical Endocrinologists, said the coronavirus outbreak had made it immediately clear how much Americans rely on medical specialists.
“It has exposed that not every person has a primary care provider,” she said, referring to people who may not regularly see an internist or family doctor.
Their first calls to the medical system could be to a specialist they’ve been seeing for a particular health problem. Specialists in heart medicine, lung care and obstetrics have training that is highly pertinent to treating the effects of the coronavirus. But specialists in other fields are hearing queries they may not be used to answering.
Endocrinologists like Dr. Weber are helping their patients coordinate extra supplies of medication, in case they need to self-isolate. And psychiatrists, especially on campuses, are facing a barrage of questions on an array of topics, like potential virus exposure and the sudden upending of work and academic schedules.
For Dr. Gauri Khurana, a psychiatrist who works predominantly with college students, the coronavirus questions began as a trickle from patients with family in China. In recent weeks, it’s become a flood of anxious phone calls from young people wondering about how they’ll complete graduation requirements or whether they might be infected.
“I don’t think a lot of them have primary care doctors and at this point everyone is terrified, wondering what’s going to happen,” she said. “I have patients that want to drop out of school, move to Canada. They’re grateful for any advice, especially coming from a doctor because there’s so much misinformation.”
So Dr. Khurana, reading news articles nonstop to educate herself on the virus, has done her best to counsel her patients on practical steps to prevent exposure: using credit cards instead of cash, wearing gloves when going outside and carrying personal items in sandwich bags. “I wish I had taken sandwich bags to work and given everyone a sandwich bag,” she said.
For specialists who treat high-risk demographics, the best medical advice for the coronavirus outbreak can feel contradictory: To stay safe, try to avoid the doctor’s office. Both the Surgeon General and the American College of Surgeons have advised that hospitals cancel elective procedures in the coming weeks, and some states have ordered postponements.
Dr. Rajeev Jain, a gastroenterologist in Dallas, sees a large number of patients with autoimmune disorders like Crohn’s. To help minimize their risk of coronavirus exposure, he has canceled appointments that aren’t immediately necessary — on a normal Monday and Tuesday he would see 30 patients, and this week he’ll see six.
Much of his time is now spent fielding calls from patients who wonder if they should stop taking their immunosuppressive medications in order to minimize risk of serious infection. Following a joint advisory from American gastroenterological associations, Dr. Jain has told patients to continue their course of normal treatment.
He worries that if his patients stop taking medications, they could contract other illnesses and be hospitalized. “That’s where a large reservoir of Covid-19 is at the moment,” he said. “That’s the last thing I want to do.”
As physicians brace for what they realize will be an increasingly challenging period, representatives of medical associations say they are moving quickly to develop and distribute resources to support their members. Patrice Harris, president of the American Medical Association, said the association had developed a Covid-19 online resource center and physician’s guide. She added that the association was aware of and working to address shortages in protective equipment for physicians, like N-95 respirators.
As fears about the virus spread in local communities, physicians are also facing unanticipated stress. Dr. Isaacs said his clinic had been robbed four times of masks, sanitizing wipes and hand soap. Dr. Supriya Mahajan, a neurologist at a private practice in Ohio, said that she’s had to confront the financial losses of converting most in-person appointments to telemedicine because her partner in the practice is her father, whose age makes him at high-risk for severe Covid-19.
And some specialists wonder whether, in the weeks to come, they might be called in to assist with front-line care. Dr. Jain works at a Dallas hospital that treated Ebola patients in 2014 and recalls when I.C.U. doctors were put in quarantine.
“We don’t know if in two weeks there will be a surge and we’ll be pulled in to take care of patients in the E.R.,” he said. “The system is already starting to get overwhelmed.”
Dr. Jain’s days are now filled with all sorts of new precautions: designating clothing just for work, removing his scrubs before coming home, hand sanitizing more often than he already did. It’s an adjustment, he said, to his routine life as a gastrointestinal specialist.
But foremost on his mind is the health of his patients.
“I’m reminded that this is why I got into medicine in the first place,” Dr. Jain said. “I need to step up now and do what I can to help.”
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