Emergency Medicine News: June 2021
Editor:
I am an emergency physician practicing at a county safety-net hospital who developed COVID-19 in early August, likely contracting it in the course of my work. Eight months later, I have only been able to return to work part time; I remain a long-hauler. The experience of developing a condition that is disabling, indeed life-altering, and that is not easily measurable by current diagnostic tests has been eye-opening for me, as I shared in a recent perspective piece. (JAMA. 2020;324[20]:2031; https://bit.ly/3ge3KN2.)
Much like acute COVID-19 and perhaps even more so, long COVID has challenged us in the variety of ways it manifests and in the challenges in finding an accurate test to diagnose it. Based on early data from patient-led surveys as well as more recent prospective data (Nat Med. 2021 Mar 10; https://go.nature.com/3gc9XJk; JAMA. 2021 Apr 7; https://bit.ly/3dlbU4D), it is clear that long COVID is widely prevalent, protean in presentation, and quite impactful for those affected. Dr. Ballard is right: We will see these patients coming to us as a last resort when other physicians, from lack of knowledge or gaslighting, have turned them away. Indeed, I have already seen patients with previously diagnosed or suspected COVID-19 presenting with persistent palpitations, GI symptoms, or dyspnea.
Such patients, rather than being a source of frustration for emergency physicians, offer yet another opportunity for us to be heroes. Let us be the ones to put the symptoms together, offering the patient the one thing that is so elusive with a disease like this that is difficult to see on physical exam or testing: validation. Let us come to the bedside with humility, acknowledging that all is not yet known about COVID and its sequelae and understanding the fallibility of our current testing capabilities.
Let it be the emergency physician who says, “Yes, I hear how these symptoms have affected your life, and I am sorry you are going through this. I want to partner with you to make sure you get connected with the care you need to start feeling better.” Let us put aside the hubris that drives physicians to psychologize that which our profession does not yet understand.
The majority of these patients will not have an emergency that requires urgent intervention or admission. It is incumbent on us, though, to understand our local resources, whether that's a long COVID clinic or, much more commonly, a knowledgeable primary care physician to whom we can refer these patients. We can also share with patients that they are not alone in their illness, even pointing them to online support communities on social media. (Body Politic has been helpful for me: https://bit.ly/2Qsguou.)
Whenever the health care system fails them, patients come to us to ease their suffering. Let us be there for those with long COVID as we have been for so many others. We're up to the challenge.
Jeffrey Siegelman, MD
Atlanta
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