Challenges of COVID force doctors, med students to hone the art of practicing medicine | Opinion
Before the pandemic, the lives of many low-income Miami residents were difficult. However, COVID-19 only made access to care more difficult for 20 percent of people in Miami-Dade County who had no health insurance as of 2017.
For decades, the Mitchell Wolfson Sr. Department of Community Service (DOCS) clinics at the University of Miami's Miller School of Medicine have been trying to fill the growing access gap. Medical students and physician-preceptors - including these authors - have cared for low-income residents for free while training aspiring physicians. These clinics have become an invaluable link between those in need of care and medical students who need practical experience.
COVID-19 has not broken that link, but has tested its strength.
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Students continue to occupy these clinics and learn from their doctor teachers. But the personal connection between a patient and a doctor, which is an integral part of the medical art, came under attack when COVID-19 hit. At first the clinics closed. Then they opened again with the necessary precautionary measures to create physical and emotional distance between clinic staff and patients. Personal protective equipment (PPE) hid our faces while brief visits and a new sense of fear became the norm.
As students and mentors, we wondered how such changes could affect the training of future doctors. It can take years to fully understand the consequences.
Previously, these clinics were one of their first opportunities for medical students to learn how to interact with real people and ultimately treat them. Doctors at the clinic taught medical students how to review patient histories and perform physical exams. These two tasks usually allow doctors to determine exactly what a patient is suffering from. Learning to perform these tasks early is critical to medical education.
Now at one of these Miami clinics, there are fewer students and attending physicians on each shift to prevent overcrowding. That means seeing fewer patients and absorbing fewer medical perspectives for the students. We are more reluctant to use the stethoscope and blood pressure cuff to record routine vital signs. We strive to enter and exit the patient's room efficiently and safely. And if we're lucky, we start talking to the students about the bed.
While access to PPE allows the clinic to continue, masks obscure the comfort that a friendly smile has given patients. New protocols mean we no longer have to do paperwork in the exam room, which gave us extra time for each patient and possibly a bit more insight into the patient's perspective. This now happens after the visit, just before the instructor tells the students how they would have dealt with the encounter had it never been for COVID-19.
Doctors and patients rely on nonverbal cues to build meaningful connections, which in turn impact the quality of care, according to a letter in Family Practice magazine. Reading a face or holding a pair of hands can tell a doctor what a patient may never say. Even a handshake can speak volumes about a patient's opinion of an encounter.
The pandemic changed all of that. What this means for medical education and future patient care is unknown.
This scenario exists in clinics and hospitals across the country because medical students at higher risk have difficulty gaining clinical experience. They also worry about their own health, well-being, and career.
But there is good news. Medical students are learning to deliver care through telehealth platforms, which could expand access to care. They deserve a frontline pandemic - something their mentors never had. Additionally, the next generation of doctors are developing solid hand hygiene habits, a notoriously sensitive issue in healthcare.
Not so long ago a couple walked into our clinic. The husband extolled his wife's energy and described her as a rock star. But she seemed to be gone. After asking a few questions, she said she became depressed during the pandemic. Revelation made it clear the importance of finding time to practice the art of medicine.
It takes time, listening, and instincts. As much as COVID-19 has threatened this art, our country's medical students and teachers will reclaim it one by one.
We need our patients just as they need us. And they need students who become doctors, who lead their community through the next health crisis. Right now, all we can do is look for ways to listen and learn - just like everyone else.
Dr. Geeta Nayyar is a rheumatologist who serves as Executive Medical Director for Salesforce and lecturer in the University of Miami Department of Community Service Mitchell Wolfson Sr. Dr. Sabrina Taldone is Associate Program Director of the Internist Program at the University of Miami / Jackson Memorial Hospital. Pranusha Atuluru is a sophomore medical student at the University of Miami Miller School of Medicine.
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