Thanks Dr. Jeffrey Borkan, family physician and leader, Providence, RI.

Jeff's wisdom and thoughts . . .

We hear about remarkable efforts in EDs and ICUs and the setting up of field hospitals – this should all be commended.  However, it has also been incredible how primary care has changed rapidly to meet the crisis in dynamic and innovative manners.  Here in Family Medicine, within the space of less than two months, we have “quaranteams”, telehealth, RITU and Testing Tents, and “warm zones” in the clinics and on the inpatient services, more virtual meetings and didactics than you can count, and even “fun events”.  Our team has been individually and collectively amazing!

New/old concepts have been re-introduced – starting with “surveillance’ and “quarantine.” Legislation for surveillance was first introduced in 1741 in the Americas, when the Rhode Island colony passed an act requiring tavern keepers to report contagious diseases among their patrons , which two years later required reporting of smallpox, yellow fever, and cholera. As you may know, the word Quarantine - a period of 40 days –has its roots in the Italian word “quarantino” and comes from the period of time set for isolation during the Black Plague of the 14th century.  The story of immunizations and vaccines began with Edward Jenner, a country doctor (aka GP/Family Doctor) living in Berkeley (Gloucestershire), England, who in 1796 performed the world's first vaccination. 

Like others, I am finding that every individual is having their own unique experience of COVID – from the annoyance at being inside too much to abject poverty and the real threat of starvation; from “COVID scares” and minor symptoms to hellish drug-induced comas on ventilators and ensuing death.  Time seems fluid – stretching forward in back in previously unknown contortions.  Just one month ago?  Feels like ages.  Just one week ahead, may seem to bear unimaginable heaviness.

My hope is that we emerge from this as a population and a world that is mostly intact, mostly healthy, and (dream as one may) more united.  In addition, my hope, like many others is that our healthcare system will not revert back to where it was preCovid, but will have learned lessons about providing the “right care at the right place at the right time – and at the right price.”  Telehealth has been incredibly successful and should be part of what we routinely offer; low value care should be increasingly censured (e.g., Choosing Wisely examples), while high value care should be increasingly rewarded.  How about dreaming bigger?  Might we consider offering/assigning all Rhode Islanders primary care doctors, as is done in other countries, not to mention the VA and Kaiser?  Might we move to provide Universal Coverage, with capitation rather than fee for service as the dominant payer model?  Might we incorporate social determinants of disease into our medical decision making –so for example, when we place someone in quarantine, we also assure that they have food, water, and electricity?  There is so much to do, however it somehow seems more achievable given how far we have come in 2 months.  Efforts are underway from the Governor’s office to consider some of these – and perhaps we can help push the envelope.

And once again, as we face these challenges and the promise of more difficulties to come may we tap into the eternal force of spring and find the strength within ourselves and our communities to hold on to hope and continue creative steps forward.