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!
Now that the State of California is officially on "Lockdown", many people are trying to figure out how to stay home and how to get everything delivered.
Although many California residents have been able to switch to various restaurant and grocery delivery services, the majority of us is still having a hard time figuring out how to handle the "sterilization" procedures for all the "incoming goods". How do you even order a pizza these days?
We have to wash our hands every time we come in contact with something that has been potentially contaminated, but in a practical sense, how do we go about doing it?
It is certainly a conundrum!
There are so many questions that come up. Is it safe to eat the food? What about cash tips? What needs to be disinfected? How? Of course there is a million points of view on the internet, but in reality, no one really knows exactly!
So here we are... Welcome to the 2020! (Everyone kept saying last year, "Oh, 2020 is going to be so much better!" I really don't know where they get their information, by people really need to start using better sources!)
But I digress... Back to the pizza delivery challenge... (Sorry, for another tangent, but have you ever thought that you would have to consult multiple experts before ordering a pizza? You have to admit, it is a little bit humorous!)
So what should we do?
Imagine you get some food delivered. If you come in contact with the person who is delivering your food or grocery items, try to keep a distance of at least 6 feet. My advice would be no cash tips or paper receipts. Hopefully, the service that you use will have better alternatives. Yes, may feel awkward and uncomfortable, but these are the times we live in. It's not easy, but we can still smile at each other and wave, it's a matter of being smart, not fearful.
I am going to compare our current situation to being at risk of exposure to glitter or cheetos (disclaimer: I love both), and if you have ever come across either one of those, you know exactly what I am talking about! Have you ever received a glittery holiday card or overindulged in Cheetos? You know that you had to keep washing your hands to get the glitter or the cheetos dust off - same is true now, we need to keep washing our hands - it is as if the whole out there, everything outside of your home, was covered with Cheetos and glitter! If you keep that in mind, it might help you figure out how to handle your deliveries, and especially the importance of washing your hands and keeping them clean.
So let's say your items have been delivered in bags or in a cardboard box. How would you unpack it if it was covered in glitter and you didn't want it in the house? I can tell you, the CDC does not have an answer! So you just have to use common sense.
Jokes aside, here is some information that you might find helpful.
From what we know as of right now, SARS-CoV-2 (the coronavirus that causes COVID-19) can stay around on various surfaces for some time:
So be mindful of that.
Personally, I set my non-food deliveries aside to be opened later - for at least 24 hours or longer depending on the contents. You certainly don't want to wait for days when you are getting your food delivered - so for food and perishables, be prepared to do some extra handwashing and extra disinfecting, followed by more handwashing.
As far as the food itself, based on what we know now, you cannot contract the virus by eating something. We will know more over time, and I will continue sharing information with you if anything changes.
In the meantime keep washing your hands for at least 20 seconds after you touch anything from outside (or use 60%+ alcohol-based hand sanitizer if you don't have access to soap and water).
Hope this helps :)
Please stay safe!
- Dr. Danilychev
PS: Just for laughs: "Cheetos interrogation"
PPS: I miss Cheetos!
As of 03/20/2020 we still don't know enough about Coronavirus transmission.
From my personal extensive analysis of the available data (references are available on this page) it is clear to me that the virus can be transmitted in the following way:
Additionally, it appears that SARS-CoV-2 (the Coronavirus responsible for this pandemic)
Check out a litter from an expert on the subject of transmission. It is really eye-opening...
CLICK HERE to view the blog post with the letter.
Please take the time to read the letter. It is important. Please share it as well.
WHAT IT MEANS FOR YOU
Be conscientious about your own hygiene and take active measures to protect yourself and others:
I know this is a lot to take in, but it will save lives.
I am sorry if the information keeps changing all the time! I will do my best to continue keeping you updated.
With love and care,
Dr. Maria Danilychev, MD
P.S.: Below are some images that may help makes sense of all the PPE (personal protective equipment)
PERSONAL PROTECTIVE EQUIPMENT
When around people outside of your home:
To protect yourself from droplets in case some coughs or sneezes on you (and to protect the others from your own accidental cough or sneeze), you can use a scarf if you are not sick and a mask if you are (PS: please don't go in public if you are sick):
PPE for healthcare workers
If you are sick at the hospital with a respiratory infection, you want all your doctors and care providers to look like the BEST photo above in the ideal case scenario.
Which masks are currently provided to healthcare workers? Very few get PAPRs, many do not have access to N95s, some healthcare workers don't even have enough regular masks, any many are instructed by their hospital administrators to wear suboptimal protective equipment to avoid "scaring" the public. Honestly, I would be more scared of a doctor who is unprotected and may be passing germs around, then the one who is fully "suited up".
Please do whatever you can to help! You don't want people in the front lines to start getting sick and dying. Who is going to help the rest of the people?
Physicians are notorious for being really bad at advocating for themselves. I've been asking everyone how is not adequately protected by their healthcare organization to speak up, but very few people are doing it. It will take a public outcry to for this horrible situation to change.
I am doing everything I can to increase public awareness of this issue which is largely hidden from the public eye and which is not being adequately addressed.
Please spread the word! Please find ways to contribute PPE to healthcare workers near you!
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.