The Veriblog

Voices of Concern: Perspectives from the ER

To provide these insights, Verilogue has engaged in voice-enabled pulse surveys with ER Physicians, and have analyzed 63 responses collected in April 2020

As of April, two distinct stories are emerging from ER physicians on the front lines of the COVID-19 pandemic.  These stories are shaped by location: those who are currently in the midst of a war-like chaos in a COVID-19 ‘hot spot’ (e.g. New York City), and those who are dealing with a sense of impending doom while preparing for a future peak. 

We present these stories through the voices of the physician themselves:

 

PEAK OF CONCERN

 

ER Physicians currently managing the height of their local outbreaks are ‘drowning’ from the extreme physical and emotional burden.

“This is like being in a war zone with a constant barrage of incoming casualties. No end in sight. No idea what resources you’ll have for the next hour or day or week or month. It is overwhelming. Stressful. Causing a major burnout as well as fear for the, uh, the people on the front line for their, for their own lives. Uh, lots of people have written wills and said goodbye to their family and never expecting to see them again. It’s absolutely devastating”

Every single thing that comes in through the door in my emergency department is COVID. Um, people are de-sating in front of me faster than I can put them on oxygen. It’s, it’s, uh, it’s a mess

These physicians are driven by their duty to treat the sick, though they are fearful of their ability to protect themselves, due to a lack of available resources (esp. PPE):

“Intubating patients with Covid-19 had been the first time in many years that I’ve actually been frightened during my practice of emergency medicine”

“It has been challenging, as we do not have enough PPE for our staff. We are having to use homemade PPE and rely on friends and family to help us. We desperately need more PPE”

Despite doing their best to treat the patient physically, from an emotional support standpoint, they are at a loss.  They recognize their inability to provide the patient with ‘a good death’ as families are not allowed to be with loved ones during their final moments.

“It’s very disheartening and frustrating. Um, you feel kind of helpless. Patient after patient comes in in respiratory distress. You intubate them and they code. There’s no family around and the pattern repeats. Another one comes in, gets intubated and then codes. All the while you hear code ninety nine over the head for the different floors, for other patients.”

“Patients are frustrated just as well as healthcare providers are. We are uncertain of what the future will look like. One of the hardest things has also been not allowing patients to have family members at their bedside or visit them sometimes even in times of death.”

Despite the experience of treating COVID-19 patients for several weeks, a prominent sense of uncertainty and frustration still looms among these physicians, due to lack of modern precedent and constant changes in disease understanding:

“It has been chaotic. Um, policies and protocols are changing every day. Every day we have a team meeting to go over what new protocols there are”

“This is unparalleled in my medical career. I have never seen anything like this before”

 

APPROACHING CONCERN:

 

Though physicians located outside of current COVID-19 hotspots do not currently suffer from the same physical burdens as those dealing with the height of the epidemic, they experience unique emotional burdens.  Despite media reports detailing the experiences of others across the country and world, these physicians recognize the many unknowns associated with this disease, leading them to question their own level of preparedness.

“We are seeing a few COVID patients right now, but anticipate that that will rapidly expand, period. Everyone is stressed due to the sense of impending disaster and lack of resources.”

“This disease is consuming everybody’s life, and their livelihood. I have been anxious, stressed out every day, and it’s very, um, sombering because I don’t know what the future holds.”

“I don’t know if we’ll be prepared fully when it does hit, if it does”

Notwithstanding this uncertainty, they have prepared to the greatest extent possible (expanding hospital beds; sourcing supplies), taking advantage of the current low hospital census and mostly-empty ER (due to the focus on treating true medical emergencies) as much as possible.

“Our hospital census is down by half, uh, elective surgeries are cancelled. Elective procedures are cancelled. Uh, some of our staff has taken furloughs. Some of our staff is being re-purposed. So, it hasn’t hit us very hard yet. Uh, we are preparing for a large surge. So, we’re taking this time now that we have a low census to prepare our staff, um, clear out areas that, um, normally wouldn’t be, uh, inpatient beds to be used as inpatient beds. Getting all of our equipment as much as we can. Our PPE and preparing to make, um, our hospital that normally has over eight hundred beds, into twelve hundred beds. We don’t know if we’ll use all that, but we are preparing for this surge”

“For right now, um, a lot of us are sitting around honestly twiddling our thumbs… We’re all ready, we’re all waiting”

“Right now I feel like we’re like in the eye of the hurricane and we are going to have a massive surge coming”

 

WHAT IS NEXT?

 

Despite the increasing clarity around the short term disease projections, long term uncertainty prominates across both ER Physician groups.  In the words of one physician currently working in a COVID-19 hotspot:

“It’s been a whirlwind, but I don’t think the chaos is done just yet”

 

Best of health,

Verilogue

 

The insights presented in this content piece were developed through a collaborative effort across Verilogue’s research team

Voices of Concern

With the spread of COVID-19, community physicians suddenly find themselves on a tightrope balancing patient, community and business health

COVID-19 Methodology: Verilogue has analyzed 89 in-office visits from December 2019 to March 2020.  In addition, Verilogue has engaged in voice-enabled pulse surveys with physicians across all specialties, and have analyzed over 103 responses collected in March 2020. Verilogue’s analysis of caregiver voice online was conducted on data recorded February 17, 2020 through April 2, 2020 across all websites sourced by NetBase. Quotes provided in this content all originate from Twitter or in-office visits for illustrative purposes of the text and represent broader trends found in various communities.

It is safe to say that we are all concerned about the spread of COVID-19. As COVID-19 spreads across the globe and infection rates increase, so too does concern spread and rise: concern for the health and safety of our loved ones and ourselves, distress over our own role in the spread of COVID-19, and worry for the future of the economy and the financial impact of this crisis in our lives.

Now, more than ever, data and knowledge sharing is critical in this era of uncertainty. Verilogue collects naturally occurring in-office HCP-PT dialogues, including telemedicine visits.  Additionally, Verilogue regularly collects qualitative surveys and feedback on dialogue from both PTs and HCPs.  Our methodologies provide a unique perspective around community physician, patient, and caregiver point of view.

Community Physician Voices of Concern

COVID-19 has had a profound impact on our community physicians. Community physicians suddenly find themselves on a tightrope balancing patient, community and business health. In addition to managing specific patient needs, they are filling multiple roles: small business owner; trusted community resource; public health educator; tech expert (telemedicine) – all while managing their own physical and mental well-being.  Because the goal is always to provide the best care to the patient, community physicians are assessing day-by-day whether the benefit of in-office consultation outweighs the potential risks (e.g. infection, concerns about quality of care via telemedicine) with many of our physicians reporting patient volumes (and revenues) half the level of the weeks prior to the pandemic outbreak; some far greater. Amid these challenges, community physicians are struggling to keep their practices in business for their patients, their staff and themselves; several have communicated that their practice has been shut down just two weeks into the pandemic with an undeniable uncertainty about the future.

Heightened Urgency

Taking a look back at recent exam room discussion, the conversation has evolved extremely quickly as it pertains to COVID-19.  Back in January, most questions were raised more as a curiosity, and were met with light-hearted responses (e.g. patients asking if the doctor has seen any patients with COVID-19; physicians saying that travel plans don’t need to be cancelled).  This is in sharp contrast to the conversations collected in March, in which these physicians are now diligently educating patients on best practices, and with patients asking specific questions around tactics, going so far as to warn patients with pre-existing conditions that contracting the virus could be deadly (and using more forceful language at times).  With this increased awareness comes the recognition that non-critical office visits should be rescheduled for the time being.

Patient and Caregiver Voices of Concern

The increased level of concern is echoed by patients, as one mentioned during an in-office visit in March:  “I mean, if I knew you were going to have so many people in your waiting room, I would’ve cancelled.  It really scares me.  Oh, I don’t want to go anywhere because I am so susceptible.”

Verilogue also captures the caregiver voice of concern through targeted social media monitoring.  An emergent theme unique to COVID-19 is the direct and intentional online engagement of friends and family members (caregivers) with loved ones who may be more at risk or vulnerable.  Fear for the safety and wellness of loved ones repeats itself online:

I’m very worried about my mother
“Terrified for my kiddo”
“My wife is a nurse…I feel your worries”

Caregiver and patient voices online reinforce the need for social distancing as a critical protective measure to those with underlying conditions or in an at-risk group, presenting social distancing both as a community need, and as a citizen obligation.  What this online trend shows us is that while COVID-19 has had deep impacts across the board, it also has unveiled to us individually the most vulnerable in our lives, and in evaluating our loved ones’ vulnerabilities we’ve been lead to ask—what is necessary? Caregiver voice resonates this sentiment, occasionally leveling unnecessary behavior or activity with selfishness, irresponsibility or even at times, cruelty. 

“Please, for my children’s sake, your neighbor’s sake, your parent’s sake, our doctors & nurses’ sake, stay home. Stop being selfish, you’re literally killing people!

While the caregiver voice is not unique to the online space, this assertive and protective engagement very much is.  We will be sharing more information in the weeks ahead, as there is already a powerful story of the impact of COVID-19 on family and loved ones developing online:

My Dad died last night from COVID-19. He wasn’t an essential worker but did not have the luxury of wfh and was required to work. My family’s lives will never be the same. Cover me and my family in your thoughts and prayers. Take care of your people”. 

“My dad passed away from coronavirus last night. He was not a statistic and neither are his family. Stay home saves lives to love your family.”

The Path Forward

Verilogue will continue to monitor the evolution of this pandemic through our collection of HCP-PT dialogues, qualitative feedback, and social listening, and we look forward to sharing more information on a bi-weekly basis as the COVID-19 pandemic evolves.  In the meantime, recognizing that this is a unique resource, we encourage anyone with interest to reach out and let us know how we can best structure these updates going forward.

Best of health,

-Verilogue

The insights presented in this content piece were developed through a collaborative effort across Verilogue’s linguistic research team

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