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A local doctor’s perspective on how COVID reshaped primary care

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While “COVID fatigue” often makes us feel that the disease has been with us forever, the reality is that the pandemic has brought about tremendous systemic and societal change within a very short timeframe. Prior to the pandemic, if one were to propose enacting wholesale changes to our health care delivery system in the span of 12 months, we would have said “not possible.”

Yet, here we are – and according to Rob DeMuro, MD, medical director for primary care at UVM Health Network – Elizabethtown Community Hospital, some of our adaptations may actually improve the delivery of health care in the long run.

Certainly, some of the modifications we’ve been forced to make due to COVID-19 have presented challenges. Indeed, a lot of our preventive health care was put on hold back in the spring, as many routine appointments and procedures were postponed during the height of the pandemic’s first wave. In line with New York State guidelines, UVM Health Network – ECH delayed non-urgent visits last March and April to stem the spread of COVID-19, and two of the hospital’s six community-based health centers were closed. This caused many providers, particularly those like Dr. DeMuro, who practice in small towns and have strong community ties, to worry what he might be missing, in terms of opportunities to help his friends and neighbors.

“I have lived and worked here for twenty years. When you practice in a small town, you really get to know your patients, their relationships, their challenges. When you are used to seeing these people and then suddenly you don’t, you start to worry,” Dr. DeMuro says.

In May, as operating hours and patient visits increased, Dr. DeMuro was encouraged to see his patients again. “To see patients and to know they are doing well is such a relief.”

Seeing patients in the context of COVID-19 now requires new layers of interpretation – figuratively and literally – as masks come between doctor and patient. Masks are incredibly effective in protecting both patients and providers from transmission of the virus, but they also severely limit our interactions. Many of the important nuances we communicate via facial expressions – a nurse’s warm smile, a patient nervously chewing on her lip – become lost in our masked world. That’s something providers have had to adapt to, in order to ensure that communication is clear and that nothing is missed.

Treating the Whole Body

One significant way that Dr. DeMuro is stepping up his communication with patients is in the area of mental health. As the pandemic enters a new phase and case counts increase, Dr. DeMuro stresses the importance of monitoring both physical and mental health. For patients reporting symptoms of anxiety and depression, he recommends integrating exercise and meditation into their routine. And, where appropriate, he works to connect them with a behavioral health professional.

He also reminds his patients that “things will calm down.” History has proven, he says, that the impact of a pandemic is time-limited. “We don’t know exactly when, but we do know things will get better. That allows us to be optimistic, especially with vaccines becoming available. I try to help people focus on the long term, and not just what feels overwhelming today,” he says.

Unexpected Positives for Improved Patient Care

That optimistic outlook also leads Dr. DeMuro to cite some positive aspects of the COVID-inspired adaptations we’ve made this past year, particularly in the refinement of telemedicine.

“One thing I like about video visits,” as opposed to phone calls, “is that they allow for body language,” says Dr. DeMuro, noting that we don’t always fully appreciate the extent to which we all use body language to communicate our health and our needs. “Being on camera allows us to see how our patients are reacting to our questions and behaving.”

Specifically, Dr. DeMuro cites the example of a patient recovering from a recent stroke. “There are nuances to a patient’s mobility, and how they speak, after a stroke, so it was important to actually see how this patient presented herself and how she was improving,” he says. Video conferences did that just as well as an in-person office visit, he says. “Eventually I saw her in the office, and that office visit allowed me to see her walk down the hallway, but I found that the Zoom visits really didn’t leave out all that much.”

And in many ways, video calls are actually more efficient and convenient than in-person appointments, more so for the patient than for the provider. When you come for an office visit, he says, “you’re driving, you’re parking, you’re walking in, you’re waiting in the reception area…whereas on video, the time is cut down tremendously and you’re waiting comfortably at home for that call. And when you hang up – click, you’re done.”

It’s probably those benefits, Dr. DeMuro says, that have caused his patients to embrace telemedicine more than he might have expected. In addition to saving time for all patients, telemedicine visits can also be a tremendous benefit for people, like the stroke patient, who have limited mobility.

“I’m one of those physicians who believes a lot of office visits could be zone via Zoom,” even once the pandemic is behind us, says Dr. DeMuro. “Seeing a diabetic and reviewing sugar control, when it’s really just a conversation, could easily be done via video. I’m pleased, he says, “we’ve been able to institute this,” and that security and privacy have quickly caught up to the technology and made it possible.

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