THINGS HAVE BEEN PRETTY BAD FOR A WHILE...
Scroll down to a section in blue below to read one doctor's experience.
Thousands are doctors around the country have their hands tied by their hospital administrators. General public is largely unaware or non-medical professionals impact patient care.
Doctors have been facing and reluctantly complying with growing impositions from a wide range of sources. Here are some examples:
- insurance companies limiting the ability of doctors to prescribe medications that would be ideal for an individual patient and many insurance companies pay doctors laughable amounts for the work they do (trust me on that)
- medical coding system (each diagnosis and procedure has an assigned number, and many of the diagnostic code names make very little clinical sense
- electronic medical record systems (the vast majority of which have completely altered the normal physician workflow and how we gather, process and share information with each other)
- legal field (there is always a possibility of being sewed even if you did ABSOLUTELY NOTHING wrong)
- hospital systems that work their doctors to death (if you don't know many doctors, that's because they are probably always at work and only socialize at the expense of sleep or some other vital necessity)
- ridiculous board exams, which in no way correlate with whether or not a doctor is knowledgeable and does an amazing job at caring for his or her patients (these exams take many weeks of study of random information we rarely use in real life, and take us away from patient care; not to mention, most of them are over $1,000 each (+ a few thousand for a prep course + $1,000 if you have to retake it) and have to be taken every 5-10 years.
For at least a few decades, doctors have been working on fumes (most work 60+ hours/week, many even more - I personally have regularly worked 100+ hours per week). We do not get enough sleep. We often don't have time to eat. I can't tell you how many times nursing staff would sneak in a plate of food in front of me while I was documenting patients histories patient charts, because otherwise I would not eat at all in the 9+ hour shift. I simply did not have time (trust me it was not by choice!). I can't tell you how often, as I was leaving work, I would realize that I have not had time to go to the bathroom. At all, in a 10 hour day! All of this is so wrong and unhealthy, but for many of us, it's our reality. Sadly, I am not an exception... Many doctors around the country will tell you similar stories.
The sad part is that things have been getting worse and worse every year. It's true that we now have work hour limitations have been placed onto resident and fellow physicians (doctors in their first years of working as physicians - no more than 80 hours/week and 24 hr/day of patient care [not including charting, lectures, etc, etc]. So yes, resident and fellow physicians do work a little bit less now than before, but as soon as you are done with residency or fellowship, this rule no longer applies. So yes, it's madness.
Going back to my point. Things are getting worse every year. Doctors are too busy taking care of patients, simply don't have time to fight the overwhelming force of external forces that ultimately impact how we care for our patients. Thus far, we've been able to adjust, each of us figuring out was to "work around" the system in order to deliver the best possible care to our patients.
Today, these major external forces have surpassed every boundary. Today, during this tragic pandemic, doctors are literally being forced to do the wrong thing! Many are threatened by being fired if they don't comply. I literally see hundreds of horrifying posts from doctors in private Facebook groups every day. The vast majority can't do ANYTHING to fight this!
Doctors are in a horrible position because they have an obligation to their patients, and even when hospital administrators do not provide doctors with proper masks, doctors are still going in because they can't let their patients die!
It is wrong for non-medical professionals to dictate how doctors should do their job. You want doctors, not administrators making medical decisions.
It is obvious. It is common sense. And yet, now more than ever, we have reached an unprecedented level of admitrators controlling patient care.
Please read one doctor's story below. Please share it.
WHAT'S HAPPENING NOW. A DOCTOR'S EXPERIENCE.
"Mostly venting. And physically sad/angry/upset at my hospital’s response to COVID. Here’s my two specific examples. (I’m FM) [Family Medicine Doctor]
1. Radiology is being told by administration that they can’t use the word COVID in their reports. It’s “scaring staff”. So they can’t say in a CXR [Chest X-ray] report “patchy bilateral infiltrates consistent with COVID,”. They just have to stop at “patchy bilateral infiltrates.” Same for CT scans, which to my knowledge, can be nearly diagnostic of COVID. We do not do this for other diagnoses. We would not hesitate on a mammogram to describe a breast lesions and say “highly suspicious for malignancy” or describe the pancreas on CT and say “consistent with pancreatitis.” Also, if/when our patients get transferred to outside hospitals, and only the imaging report goes, not the images, the receiving doctors will need to read between the lines.
2. There are two small hospital systems in my entire county. On Friday, the media reported that my county had the first positive confirmed case. The two hospitals released a joint statement saying that The case was not at either one of the hospitals. This confused me. Then my Hospital went out of his way to make another statement on Saturday again reiterating that the case was not at our hospital. However, I know that my hospital like we has four or five pending cases. I’m angry that my hospital system is either trying to deceive the public, downplay the situation, or make it look like we are still a safe place to come because COVID “is not here”. Or maybe there’s another tactic that I don’t understand. But I don’t like it.￼￼￼￼￼"
Family Practice physician
(Publishing anonymously per doctor's request)
Administrators can’t tell us how to do our jobs. If the radiologists stop using the phrase “consistent with...” it may potentially affect clinical decisions that other doctors will be making (those who provide direct patient care based on on the the radiology reports). Which means, if radiologists comply with what hospital administration demands of them, it may cost people’s lives.
Our primary obligation as doctors is to our patients, we all gave a “do not harm” oath. This obligation is much stronger than any other duty we have to our employers, or others who impede good patient care. We have never in our careers had to experience such a discrepancy between what we are told to do and what is right. On top of that, doctors who are trying to do the right thing, are being threatened with being fired.
Here is the thing. It's not that doctors are afraid to lose their jobs. No, they are not thinking about themselves. Doctors are concerned about patients and who will take care of them if the doctors are not there. They do not want to be forced to abandon their patients because the hospital administration is making wrong decisions.
That's why doctors find all this to be so overwhelming. They are stuck between a rock and a hard place.
As you read these words, I hope you can understand the tough position the doctors are in right now.
If doctors don't have the right masks or other protective equipment, they should not be treating patients potentially exposing them to the virus. Please refuse to be seen by a doctor (or any healthcare provider) who is not properly protected.
Doctors should not be told by their hospital administrators how to their job. Doctors should not be risking their jobs if they are doing what's right.
Don't let some bureaucrat decide your fate and the fate of your doctor.
Please help your doctors. They are there to help you. They put their lives at risk to help save yours. Ask your doctor what you can do to help.
If you see something like this happening in your community, please talk to the press! The doctors can't help themselves right now. They need you to help them take care of you the right way.
Please share! People have to know!
EXPERT VIEW ON VIRUS TRANSMISSION
I spend hours going through all the available data on SARS-CoV-2, the virus that is causing current pandemic, I also communicate daily with front-line physicians and experts, who understand this disease better than all of us.
Many of these frontline physicians are not able to share their experiences publicly out of the fear of retaliation from their hospitals' administration and also out of concern about the reaction of the public. In the end, this important information needs to be shared so that the people can make educated decisions about how to protect themselves and how to help protect their healthcare providers:
Below is a letter from one of the doctors, whom I consider to be an expert :
A LETTER FROM AN EXPERT
"I have debated whether to post about my suspicions regarding airborne transmission of SARS-CoV-2 and COVID-19, whether I’d be causing unnecessary panic over something we can’t do a whole lot about. I think it’s time.
There is much I can’t say in public that’s scaring the crap out of me and keeping me up all night. Those of you who know me well, know that I research exhaustively and am very logical and data driven. The data is bad.
I am the lead author of several publications on aerosol deposition in the airway. So when I talk about aerosol inhalation, I have more in depth understanding of this than most physicians. Not all—some know a lot more than I do. But most.
Airborne vs droplet precautions are archaic.
Airborne precautions require healthcare workers to don previously fit tested N95 masks or PAPRs (powered air purifying respirators), in addition to eye protection, gown, and gloves. Fit testing, which must be done before a healthcare worker can safely use N95 masks, ensures no air can be inhaled through gaps between the wearer’s skin and the edge of the mask. This is critical. Droplet precautions require a regular surgical mask, gown, eye protection, and gloves.
Airborne transmission relates to an infectious agent’s ability to infect others at a significant distance through aerosols. Aerosols are small particles of potentially infectious material generated by coughs and sneezes.
Aerosols remain suspended in the air for some time. They don’t immediately fall and land on surfaces like the larger particles, droplets, do.
Aerosols suspended in the air can infect others in close proximity, even if a disease is not classified as “airborne.”
We know the coughs of a healthy person generate aerosols. not just droplets. We know viral infection (specifically influenza) can increase the percentage of small aerosols generated by a cough. We know small aerosols penetrate deep into the lungs. This is thought to be a mechanism by which influenza enhances its transmission from host to host. SARS-CoV-2 might be able to do the same. We just don’t know yet.
Small aerosols <= 5 micrometers reach the lung alveoli when inhaled. That means the deepest lung tissue, where gas exchange occurs.
SARS-CoV-2 remains viable in the air for hours, at a minimum, when aerosolized in vitro. And it is postulated that the method of transmission on cruise ships may include true airborne, through the ventilation systems.
A regular surgical mask doesn’t protect the wearer against aerosols. It only helps to protect against droplets, for those in close proximity to expelled airway secretions. It also helps to keep the wearer’s own droplets in, to protect others and to maintain sterility. But it won’t stop anyone from inhaling aerosols
Asymptomatic and mildly symptomatic people are contagious, as are their coughs. They probably don’t know they have COVID-19, and probably aren’t socially isolating. The cases we know about are just the tip of the iceberg. You’re probably breathing the virus in from someone’s cough, even if you don’t know it, as well as contracting it through contact with droplets, contaminated surfaces, and possibly the fecal-oral route. If people don’t start DRASTICALLY socially isolating, we have no hope of flattening the curve.
HEALTHCARE WORKERS NEED N95 OR PAPR DEVICES NOT TO DIE. Please help by contacting your local, state, and national representatives, as well as philanthropists, to make them aware of the urgency of our need. And please, please stay home and stay away from others. Your life, the lives of those in close proximity to you, the lives of those you meet in passing, the lives of healthcare workers who may treat you, and their families’ lives, depend on it. Thank you."
Anonymity preserved per doctor's request
Dr. Maria Danilychev, M.D., is a San Diego based medical doctor with 20 years of experience and board-certified in Internal Medicine, Geriatrics, Hospice/Palliative Medicine, and as a Hospice Medical Director. Dr. Danilychev also conducts clinical trials and was one of the first responders during 9/11.