Can I change the channel?
I found myself asking this when I woke up this morning. It was a night of problem solving dreams, or rather problem solving attempts. These are difficult times, and I have it good. I can pay my rent, have food, I have health insurance purchased through the state affiliation with the ACA, and I'm not worried about domestic violence in my home, and no loved one is sick, yet. I try to avoid the news, it has gotten particularly dreadful, but humor helps and if you haven't seen the SNL skit with Brad Pitt playing Dr. Anthony Fauci, check it out. Short version on CNN and longer version from NYT.
That said, we have a tough row ahead for primary care. One of my UK general practitioner colleagues sent this interview with the editor of the Lancet medical journal about what the loss of US funding means for the World Health Organization. Those of us in family medicine and primary care have big challenges ahead. Telemedicine has moved ahead by leaps and bounds and that is a good thing. I found fifteen phone visits much less of an energy drain in a half-day than the same number of in-person visits would have been. More than half were done with an interpreter and most were not Covid-19 related. But who wants to see patients by phone all day. And who do we need to see in person and what can be managed on the phone as we get beyond this contagion crisis? And when will we move beyond this crisis? The focus on the emergency has closed or threatens to put many private practices out of business.
Disruptive change is happening. Fissures in US health care are exposed. These include the inequity--lack of health insurance, lack of internet, lack of transportation to get to testing sites, higher rates of sickness and death if your skin is brown. In addition, our inability to have rational discussions about advanced directives and living wills troubles me. Friday I talked with the daughter of a 92 year old woman who was sheltering at home with home care and had had 2 weeks of symptoms that very well could be Covid-19. She needed a test, and we arranged that. I wasn't her primary care physician, so I didn't broach the topic of what if she was positive and her condition deteriorated. How far did she and her mother want doctors to go? Had they discussed end of life wishes? While our emergency and intensive care systems have done a marvelous job, I can't help asking are we going too far? How do we do this differently so we don't bankrupt our system and can do a better job of funding public health? This is what causes my restless dreams.
But I am staying sane by getting outdoors. Yesterday we got up early to see the steam rise and the dew glisten in the early morning light in a Wildlife Management Area call the Great Swamp. The swamp was the site of the Great Swamp Massacre, the deciding battle of what is known as King Phillip's War, an armed conflict between English colonists and the American Indians of New England in the 17th century. The number of Native Americans killed in proportion to the population was so hign that the conflict is considered to be the deadliest war in American history. Many of the survivors were forced to or chose to move out of the area and to join tribes in New York and Wisconsin. Deep in the swamp, we found Rhode Island historical cemetery #56, hidden in brambles, which held the graves of the Wilcox family that dated back to the revolutionary war. The beauty of the morning light somehow balanced the understanding of the horrors that had happened on the ground on which we stomped.
Life is short. We are trying to make the most of it. I can't change the channel, and this is a tough one. I tell myself be grateful and find the things that give me joy. Wishing the same for you.