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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