“Whenever I start an encounter with a patient and say,” How are you? “Our conversation is going a very different way these days than it was a year ago,” said Dr. Heather Gantzer, Chair of the American College of Physicians’ Board of Regents, during a recent interview with HCPLive®.
She went on to explain that such a simple question is now tied to implicit considerations about the patient’s mental and emotional health, social well-being, living at home, everyday life, and physical activity.
As an internist, Gantzer found that her conversations with patients had to radically adjust to focus more thoroughly on these issues – many or all of which were largely affected by the COVID-19 pandemic.
“These are things that might have been fifth, sixth, or tenth on the list a year ago, but now light has been shed to show that these are critical to all of the rest of the conversation,” she continued away.
These words indicate a potential undercurrent in patient care across the healthcare industry, regardless of specialty.
During the last 12 months of this pandemic, doctors have had to take note of the lifestyle changes and the resulting crises (mental, emotional, etc.) that many of their patients have faced.
Because of this, the internist, cardiologist, dermatologist, rheumatologist (and so on) likely had to leave their comfort zone and approach care more holistically.
As seen with Gantzer, the conversations between different disciplines certainly had to evolve to accommodate the complex challenges posed by the paradoxically fast-paced and still isolating world of the pandemic.
In essence, the psychological, emotional, and physical effects of the COVID-19 pandemic have further challenged and pushed the boundaries of the healthcare industry’s apparently goofy structures.
Those months have only reinforced the idea that patient care must start with the patient first – and that the context in which they live their lives really matters.
In a perspective article recently published in the New England Journal of Medicine, Dr. Megan Evans, MPH, Tufts Medical Center et al., That “This pandemic has reinforced important truths: Inequalities related to social determinants of health become common during a crisis and protection on the ground does not bring the same hardship to all people. “
In addition, they stressed that the lockdowns have particularly weighed on those with economic, professional and domestic instability.
The play particularly focused on issues of intimate partner and domestic violence, a reality for 1 in 4 women and 1 in 10 men.
It was also found that staying at home assignments exacerbated these problems – especially in color communities and especially for those whose life situation has already proven difficult.
Of course, such concerns are just one of many problems faced in an isolated society. In a broader sense, the mental health crisis is a facet of the pandemic that has been widely discussed by health professionals in the media.
What seems to have come less of a focus is the way these crises have impacted relationships between health care providers and patients.
“Healthcare professionals have the ability to identify and counsel these healthcare patients, and connect people to social services,” suggested Evans and colleagues.
The pandemic-induced bans have also resulted in a general shift in physical activity, forcing many to lead relatively sedentary lifestyles, a reality that all doctors must acknowledge.
Data has shown that individuals, especially young adults, were largely involved in low levels of physical activity, high levels of physical inactivity, and long sleep over the course of the pandemic.
An article published in Sports Medicine and Health Sciences highlighted the importance of maintaining physical activity, especially the risks posed by the lockdowns and the virus itself.
“It is conceivable that this dramatic lifestyle change as a result of immobilization (hospitalization and bed rest), quarantine and physical inactivity could cause a second wave attack on the health and wellbeing of the infected and the general population,” the authors wrote.
So, when speaking of the health care impact of the COVID-19 pandemic, viral infection and the resulting illness is only part of a larger mosaic of patient risk and impact.
It is this sincere appreciation of these various pandemics within this pandemic and the desire to respond that can inspire a healthcare professional to approach care in a more calculated, holistic, and inclusive way.
Inclusive care is not a new concept in the health care industry, yet the physical and mental crises had led health professionals to continue to appreciate its practical value.
Defined as “practices [that] In general, emphasize a holistic, patient-centered approach to health, healthcare, and wellbeing – often including psycho-emotional, functional, social, and even spiritual aspects. “Integrative care may only have only just gained a foothold in these 12 months.
“[These considerations in care] are really important aspects that have been there all along, ”remarked Gantzer. “But it was under the surface and we often don’t notice it. Now these become more open due to the change in the setting of the patient encounter. “
Of course, it is up to them to decide how much a physician will incorporate an “integrative” approach into their practice, but the basic ideas have nonetheless become an integral part of pandemic care.
For Gantzer, she found that her relationship with patients has become more informal as her role as a health care provider has been given a new meaning and emphasis.
Her conversations have considered her patient’s physical and social life, diet, stress, barriers, and values while addressing her specific conditions and helping them achieve their care goals.
Pediatric dermatologist Lawrence Eichenfield, MD, told HCPLive that switching to telemedicine has enabled him to better assess the patient’s “heart rate” at home.
“The conversations we had to adjust are [patient] Social history, ”said Eichenfield. “For our pediatric patients to young adults still in school, we had to evaluate what that means. This is just to get a sense of what the flow of your life might be like. “
And so this thread, which takes up the patient experiences of Eichenfield and Gantzer, was the recalibration of encounters in the light of logistical and socio-emotional / mental landscapes.
The promise of integrative care
These adjustments that the healthcare industry had to make go beyond simply overcoming logistical challenges.
The more important story, which is much more subtle and nuanced, is the ongoing reassessment of doctors’ relationships and approaches to care.
Should internists focus solely on internal diseases? A dermatologist on the skin? How could a doctor best serve his patients?
These reassessments preceded the pandemic a long time ago – even in the time of the hippocracy and Galen – but it is perhaps in times of global crises that such introspection floods the naturopath again. And the COVID-19 pandemic is no different.
Where is the healthcare industry going from here?
Perhaps these literal and metaphorical pandemics, which will not come to an abrupt end, will continue to inspire innovation in patient encounter and practice. Perhaps one day integrative care – in moderate or extreme forms – will necessarily become established across disciplines.
Perhaps the walls between an internist and a dermatologist and a psychiatrist will no longer be built so rigidly.
Inclusive and holistic care, as well as the ability to understand patients in their true, unfiltered context, may offer physicians the opportunity to further develop their practice and treat patients more effectively and purposefully.
Perhaps we have learned from last year that optimizing care begins with the first reading of the patient’s “life pulse”.
And the rest follows from there.
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