Chandra's corner - May 2020

Dr PH Chandrasekar

It is mid-April now. News of Coronavirus has eclipsed virtually everything else – hospital, medical school, home, television, streets, politics, every aspect of life. Not much longer, I sincerely hope.

Just talked with Suneetha (practicing ID in Hyderabad) – seems like they are prepared and happily, things are under control – "we just need more testing", was the theme loud and clear.

What is life like for an ID specialist in the midst of COVID, in Detroit? Personal Protective Equipment remains scarce and Infection Control advises to keep traffic to a minimum in and out of COVID patients’ rooms. As a result, the ID physician, like most consultants, largely performs ‘remote’ consultations, based on computerized data showing histories and physicals, laboratory information and radiology. No longer is there a team sitting together for patient care discussion – the fellow sits in his/her room, the residents sit in their cubicles – all bleary eyed staring at the computer screen for long hours, and feverishly talking into their cell phones with one another. Students are to be found nowhere. The Emergency Room physician and/or the Internal Medicine resident may be the only physicians that may have physically seen, talked with and examined the patient. Based on that single note, and laboratory data, most management decisions are made. What, I ask, is missing in this picture? The “soul” of the consult – the direct encounter between patient and the consultant – is absent! ID subspecialists have always prided themselves on making accurate diagnoses at the bedside, just based on their skillful history taking and spot- on physical examinations. That has been a characteristic hallmark or bedrock of our specialty. Corona has stolen that ability from us and have us crippled. Without the “soul”, without firsthand information, the consult recommendations are inherently weak. The valued contribution of the ID specialist is seriously compromised, in my opinion. Furthermore, through this practice, the house staff may conclude that effective care can be planned and rendered based on computerized data alone and direct patient encounter may be superfluous and can be dispensed with. There is speculation that this may become the standard of care in the future. Telemedicine will flourish, as human contact with patient diminishes. Can the message be any more wrong or dangerous?

Hold on. Even more importantly, the ID specialist, without ever having seen the patient has no “connection”. I cannot tie the data to a face and follow daily progress. Each day I ask the fellow for the whole story to be repeated. As such, it has become impossible to develop empathy or make human connection. Even transfer to the ICU does [not have the impact or evoke a feeling it should; nothing stirs inside. Data remain as mere numbers and not felt as human suffering – the result of failure to connect.

I long for the days when I can pull up a chair next to the patient, look him or her in the eye, establish trust through a smile, reassuring voice and gentle touch. Just as much as I long for this, am certain, the patient wishes the same, even more so. Don’t you think?