Article

How COVID-19 is changing the practice of medicine

March 18, 2020

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The COVID-19 viral pandemic may be just getting started in the U.S., yet it has already changed the rhythm and flow of medical practices across the country. Call volume from worried patients is on the rise. Staff are taking new measures to protect their health. Clinicians are donning a gown and gloves, goggles or eye shield, and an N95 respirator or facemask when they see a patient suspected of being infected with the virus. And pre-office triage has never been more important: Determining who needs to be seen in person and who can safely remain at home has implications for the patient, the health of medical workers, and for the public.

“We’ve been getting lots of calls and messages from patients who think they might be infected,” says Dr. Michael Burke, a family physician in Delray Beach, Florida. “I’ve never been so grateful for telemedicine — we’re doing all we can to give patients easy telemedicine access. When patients come into the office — for any reason — they’re all extremely anxious to discuss how COVID-19 might affect them. Each visit is taking longer as a result. Discussing COVID-19 has added at least an hour to my workday.”

In the midst of these challenges, the timing of the COVID-19 pandemic is also problematic. The first few months of the year are prime time for flu season, which we have been tracking on the athenahealth network again this year. Symptoms like fever and cough are seen in both flu and COVID-19 virus infections. Beyond colds and flu, tree pollination at this time of year means that spring allergy season is now underway, leading to symptoms like sneezing, congestion, dry cough, or worsened asthma for some patients. There are a lot of reasons people are coughing this time of year, and that complicates diagnosis.

To make informed decisions, physicians need to keep up with the evolving guidance from the Centers for Disease Control and Prevention (CDC) for healthcare professionals on the front lines of the COVID-19 pandemic. Walt Hadikin, MD, a family medicine physician and medical writer at athenahealth, notes, “The CDC does a tremendous job in getting the word out about their recommendations via the CDC Health Alert Network, in its Morbidity and Mortality Weekly Report [MMWR], and online at cdc.gov, as well as hosting frequent Clinician Outreach and Communication Activity conference calls that cover recent updates. However, a busy physician with a loaded clinic schedule needs almost instant answers for each patient, whether it’s a pregnant woman spiking a fever, an older man whose chronic cough is worsening, or a family who’s just returned from a vacation in Europe.”

Dr. Hadikin and his team have been sharing CDC guidance through the epocrates app since the H1N1 flu pandemic of 2009. As COVID-19 emerged, they were inspired to transform the CDC’s authoritative guidance into a free, interactive decision tool inside the epocrates mobile app for clinicians. In less than a minute, clinicians can access the CDC’s updated guidance relevant to their patient’s situation, directly from their mobile device. As COVID-19 cases began to rise in the U.S. this month, views of the guidelines increased 600% over 10 days, receiving seven times more views than any other set of guidelines in the app.

“Given the current pace of change with this pandemic, it’s reassuring to know that modern information technology can disseminate updates to clinicians everywhere in nearly real time,” says Dr. Hadikin.

Anne Meneghetti, M.D., is Executive Director of Medical Information for epocrates, an athenahealth service, and has a background in pulmonology and critical care medicine.


View the epocrates COVID-19 decision tool