5 Biggest Impacts of Covid-19 on Primary Care Doctors

January 20th marked 3 years since the first US COVID case was reported in Washington state. 3 years into this, and a lot of things have changed. I’d argue nothing feels quite the same.In healthcare, we’re still dealing with the impacts every day. We’ve had so many unexpected changes - in the way we provide care, new types of care being needed, major staffing shortages, and seeing the medical field be used for political gain. While I can say we’ve settled into a new working state, it is not the same as before the pandemic.

As this anniversary came and went, I found myself reflected on how my professional life has changed. While it was hard to choose, below I lay out the 5 biggest impacts on my practice as a primary care doctor.

1) Explosion of Virtual Care and Telehealth

This is the biggest change in my practice. If you would have told me 3.5 years ago that I’d be doing virtual visits from a home office I would have laughed. That’s not being a doctor! Is it? Well this change has had the most positive impact on me personally. It means I get to cut commute times during the week spend more time with my family, and talk with patients wherever they are at – work, home, out and about. Working at the VA, patients were already familiar with phone visits. A service we could offer since we are not coupled to insurance reimbursement (which buy the way only paid doctors for in person care, hence why the old outdated system persists).

It was a rocky start but patients seem to have come around to the convenience of this, and understand that they are very likely going to get in faster with a call or video visit, and if we need to take it into the office, they will have faster access because I’ve already determined what is needed.

Face to face in person health care is NEVER going away, but I think there is a perfectly happy medium. I am fortunately to work some where uncoupled from insurance billing so we could be flexible on day 1, and even before the pandemic they were testing the waters of virtual care and tele-health. It went from a trickle to a water hose overnight!

2) Need to Dispel Conspiracy Theories and Misinformation

For my whole career some patients declined vaccines. Generally after a little explanation of the purpose and benefit, many end up accepting, while others still politely decline. This was totally fan and customary.

But with COVID, when people were not getting vaccinated, it felt personal! How could you not protect yourself and your family and all the people out there from some new scary disease that could kill your grandma?! We have difficult conversations in medicine every day. But I had never experienced so much inner turmoil from what felt like it should be a simple conversation giving information and advice.

I also never would have imagined a doctor needing to dispel misinformation. Maybe is a sign of the times. When patients told me about conspiracy theories, at first I was mad. Mad and frustrated that patients would believe undoubtedly the information they heard from unknowledgeable media and political pundants, who were clearly taking advantage of the situation. Then I was sad. I felt bad that people were so easily decieved, and likely had no way out of their believes. Then I had acceptance. I no longer tried to convince people that science was right and what their friends’ cousins’ mother-in-law heard on a facebook post was a bunch of baloney. I approached these conversations with intrigue (I am an internist after all, curiosity is in our blood!). And in the end, all you can say is "that's interesting and this is what I know as a doctor." If the conversation ends there , it’s totally fine.

3) Patients Still Trust their Primary Care Doctors

This is the flip side of dispelling misinformation. Often patients turn to us because they need a trusted authority to get answers from. Research from focus groups showed that by and large, people wanted to get information from their doctors and not the media. After witnessing the political attempts to get people vaccinated or keep them unvaccinated, it was reassuring to hear that people wanted to hear from their DOCTOR about the vaccine and get personal advice. Another win in the bucket for primary care doctors everywhere.

4) The Realities and Unknowns of Long COVID

The impacts of Long covid are many and different. Fortunately, most people who get infected with Covid-19 never develop long Covid. But if you have chronic diseases or end up in the hospital, you are at higher risk of having lasting symptoms.

Long Covid is a new diagnosis and the medical community is still trying to figure it out while helping patients recover at the same time. Symptoms are so broad, ranging from heart problems, immune system dysfunction, nervous system issues, and problems with kidney, pancreas, lungs, and blood vessels. Essentially, it can impact nearly any organ symptom and create disabling symptoms.

The current hypothesis include persistent Covid in tissues, immune disregulation, changes in microbiota, microvascular blood vessel problems, and disregulated signaling in the brain or nerves.

At the moment there is no good or single treatment, often the treatments are symptom based and supportive in nature. Long Covid clinics are popping up all over the country particularly in academic health centers. As of now, our best chance at combating long Covid is to prevent it in the first place through vaccines, anti-inflammatory treatment for severe covid cases, and by healthy nutrition and lifestyle.

5) Be Open to Change

As I said in my intro, adaptation has been the name of the game, not only in healthcare, but in all our lives. But especially in healthcare. Systems went thought daily, then weekly, then monthly town hall updates, many of which still persist, but morphed into other topical updates. One thing was key: communication communication communication. There was never enough. It was impossible to keep up. Internal operation commands to oversee what was going on with cases, staff, supplies, oh my. It was not a small impact on health systems and health care providers. These were real impacts on real people, being asked to do things that were not their ‘normal’ job. 3 years later, many have burned out and left medicine, or moved on to new opportunities. It’s hard to run on high speed for 2 years straight when you realize the race has no finish line. But it has changed from a sprint to a marathon. So you learn to slow down to a meandering pace, take in the sites, smell the fresh air, and grow as you go.

Conclusions

So there you have it - my top 5 impacts of Covid on me as a doctor. My full list included others and perhaps I will include those in a future post. Let me know if there is more your'd like to hear on any of the topics covered in my posts.

What about you - how has Covid-19 impacted your personal and professional lives for the long term?

References:

Davis, H.E., McCorkell, L., Vogel, J.M. et al. Long COVID: major findings, mechanisms and recommendations. Nat Rev Microbiol (2023). https://doi.org/10.1038/s41579-022-00846-2

Koc HC et al. Long COVID and its Management. Int J Biol Sci. 2022; 18(12): 4768–4780. Published online 2022 Jul 11. doi: 10.7150/ijbs.75056