HARVARD MEDICAL SCHOOL PRIMARY CARE REVIEW

In Times of Crisis, Family Medicine Rises to the Challenge

May 12th, 2020

We are all looking forward to the day when COVID-19 no longer dominates the news cycle, nor our lives. The ongoing conversations about treatment, improving preparedness, and how we move forward are vital and must continue. However, I would like to make a quick aside to these discussions and share why I am grateful for my Family Medicine training. A crisis is not a common time for gratitude, and I admit that I have felt plenty of despair during this pandemic. All the same a recurring thought keeps coming to me that provides me with some comfort: “I was trained really, really well.” My residency unfortunately did not have a Managing the coming viral pandemic curriculum, but like other Family Medicine and primary care programs, it did teach us to be comfortable providing care for patients across a variety of settings and acuity.

Some outside of Family Medicine may wonder what a field that seems to specialize in physicals and chronic disease management could offer in a viral pandemic. The answer, thankfully, is so much! First, those aforementioned skills enable us to form longitudinal, trusting relationships with our patients. As a result, we are their main entry point into the health system. In non-pandemic times patients will present with a range of concerns from wanting a second opinion (i.e. my opinion) on what their oncologist said; to help figuring out what insurance they need now that my office joined an Accountable Care Organization; to acute decompensated heart failure. This level of trust ensures that in a crisis our patients turn to us for information on how to stay safe and are more likely to follow social distancing and self-quarantine measures that slow the spread of this disease.

Another major benefit of Family Medicine comes from the broad-based training we receive not only in prevention, but also in urgent/acute care and hospital medicine. Since we have this background, many of us continue these practices as part of our careers as it enriches our experience. In the current pandemic, however, this means that my organization has a large talent pool that could be rapidly reassigned, with minimal up-training, to manage the challenge on both the outpatient and inpatient settings. For instance, a dedicated respiratory clinic was created practically overnight that now cares for hundreds of patients daily who are either COVID positive or may have COVID. This clinic is staffed by primary care physician assistants (PA’s), family doctors, internists, and others who were already prepared to manage these conditions because it is part of their routine job description and expectation as primary care provider (PCPs). Their efforts have demonstrated many additional benefits too. They slow the spread of the disease by keeping sick patients out of other clinics. They help to unburden the health system by keeping patients out of the emergency department and hospitals.

This breadth of training also means that providers who do inpatient hospital work as part of their job (like me) have been able to join the full-time hospitalist pool to strengthen their hospital’s ability to care for the increased volume of sick patients. I encounter my primary care colleagues at the hospital every day now, in Tyvek jump suits and face shields, applying the skills we already have. These two examples I’ve listed are just a sampling of the ways in which PCPs have adapted to this current environment. All the while we and our Family Medicine brethren continue to be available to our longitudinal patients in the form of telehealth visits or in-person when needed. We all wish that our abilities were not needed in this way at this time, but we are all thankful that we possess them.

**Feature photo obtained with standard license on Shutterstock.

 

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Dr-Jeremy-Stricsek-MD

Jeremy Stricsek, MD, is a Family Medicine doctor in Somerville, MA. In addition to the variety Family Medicine has to offer, he also enjoys being a medical educator to resident physicians, medical students, PA students, and NP students.

 

 

 

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