Old Time Medicine

While on the phone today talking to a presumptive Covid patient, it struck me that I was practicing Old Time Medicine. I practice in Westchester County, NY right where the Greater New York City epicenter began.

As a general internist solo-practitioner, I make my own rules. Every other medical office in my building is closed. Their corporate bosses decided to send the doctors home to practice computer medicine. It would never occur to me to shut my office. I’m a doctor. I don’t run away from a pandemic. I run into it. Don’t get me wrong. I’m not on the front lines. I make sure that we don’t let my uninfected patients come in contact with an infected one. The few non-infectious patients that need to be seen come in early in AM, what the grocery stores are calling senior hours. Anyone with possible coronavirus is screened on the phone and mostly treated by phone.

I have seen the spectrum of disease that you would expect in primary care. Not really ‘seen.’ Mostly ‘heard.’ We have the worried well to the mildly symptomatic to those who have full-blown Covid-19. I have patients who have either tested positive elsewhere or have had close contact with known cases and are now sick.

What can you really do for the person who is in his second week of 101-102 fevers? He knows as well as I do that being a diabetic puts him at higher risk of death. So does the 74-year-old woman who tested positive in an ER and was sent home because she didn’t need to be intubated. 

Treating patients during the time of Corona is at once at a challenge and an opportunity. I thought about how it must have been for our predecessors who didn’t have effective treatments for the disease but knew their prognosis. Put on a brave face. Extract information. Listen to the strength in the patient’s voice. Can she speak in complete sentences? What does the fever chart look like? Has the fever broken? Has the appetite returned? Prescribe rest, but not too much. Prescribe hot soup, tea. Educate. Distract. Tell a good story. Reassure. And pray that they don’t deteriorate.

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  9 comments for “Old Time Medicine

  1. Pat
    April 4, 2020 at 12:39 pm

    Bring back laudanum.

    Oh right, now the compassionate government will punish us for that, too.

  2. Steve
    April 3, 2020 at 7:02 pm

    Excellent post! We’ve been saying the same thing in our office. I feel like we’re back in the 1920’s.

    • arf
      April 3, 2020 at 10:57 pm

      Dr. Howard, Dr. Fine, Dr. Howard?

      • Steve
        April 4, 2020 at 8:56 pm

        My favorite stooges of all time!

        • arf
          April 6, 2020 at 3:55 pm

          I had that audio clip as a ringtone.
          You get funny looks on rounds, I must say.

  3. Jesse L Belville,PA-C
    April 3, 2020 at 1:19 pm

    All right my kind of Physician. Thank you: and what dose of Hydroxychloroquin 200 or 400 mg po once a day?twice a day for 5 to 7 days? are you giving.are you also giving Zithromax 250mg 2 po today then 1 po daily for 4 more days. They both seem to help? But no official recommendations as yet. Do they treat the virus or modify the immune system storm triggered by the virus? So many questions.
    No we are not old time Docs with reassurance and supportive care only.No other options. We have options but the centers are slow to tell us their preliminary results. Very frustrating. But we will find answers and do the right things for our clients/Patients. Course I am just a PA-C, with 43 years in primary care,Emergency Medicine,family practice still doing what I love,going to where I am needed.. Open clinic ,small, quiet, with DM,HTN,alcoholism,drug addiction patients. Now appointments only,screened at door or by phone,waiting on rapid test kits to arrive. 1 person at a time,a day at a time.

    • Russell Kamer
      April 4, 2020 at 9:08 am

      I give everyone a Z-pak. Just I’ve done for practically every URI that comes to my office. Us “PMD’s” are berated for overprescribing antibiotics, but now I feel vindicated. After all, one of the people calling may actually have a bacterial infection, maybe even pneumococcal pneumonia. It’s an extra bonus that it might help covid. I don’t Rx plaquenil, though I’ve thought about it. There just isn’t good evidence yet- besides, the Governor of NY has prohibited doctors from prescribing it for off label uses.

      • April 10, 2020 at 2:31 pm

        Isn’t it still illegal in NY to practice medicine without a license? Or does the current governor have a license? Oh wait, he’s the governor, he has immunity!

  4. Dave Mittmam, PA, DFAAPA
    April 3, 2020 at 11:39 am

    Russell:
    You sound like a great physician. Thanks for the great work.
    Dave the PA

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