My 2020 reflections on working as a family physician during COVID

Since the beginning of the pandemic, my day-to-day life has drastically changed.

I wake up, unrefreshed, and go for my morning run, which varies from a slow, meditative jog to short, angry sprints. I get back home, shower, make a protein shake and drive to work. The streets are deserted. Those out and about are driving recklessly and disregarding red lights, as police presence is scarce.

My day at the office starts with drinking plenty of water, brushing my teeth, brewing coffee and basking in the silence. When 9 a.m. arrives, I gear up in worn-out personal protective equipment (PPE), ready for both the physical and mental challenges ahead: To cry with patients, to send them to outside testing locations (knowing that the strict criteria will likely make this objective futile), to keep them calm when I don’t have the answers they seek.

From 9:30 to 10 a.m., not a single soul appears at my door. Normally, I would have already done a few joint injections, medication refills and gone over laboratory results, but today … nothing. The silence is no longer calm; it is deafening. Defeating. The silence is eventually broken by our first patient.

A patient who’s not herself

Patient A: She is very nervous and is apprehensively waiting outside my office gowned and gloved from head to toe and wearing an N95 mask which looks newer than mine. Chief complaint: physical and medication refills.

We talk for a bit and before concluding, she anxiously gets up to leave, refusing all studies. Trying to maximize this visit, I ask her to stay for an ECG, to which she consents. As I leave, she begins walking out, mumbling something under her breath. She gets in her car and drives away. Surreal. I feel pained, as I know this patient well and she is acting out of character.

Telemedicine struggles

Patient B: I’m in the middle of a telemedicine encounter when my PA interrupts me with a frantic look. Her patient has a hernia that is tender and irreducible, and the patient has rebound tenderness to palpation.

Immediately realizing that the patient may need emergency surgical intervention, I inform the patient that she needs to go to the emergency room. She refuses, sobbing that she is a single mother, recently unemployed, has no family in town and is caring for her baby (who recently was released after a month-long hospital stay) along with her three other kids.

Time to think. I call a surgeon colleague who thankfully is still accepting new patients and agrees to see her the next day. I give the patient the referral, ER indications and move on. Breathe.

As I begin to focus on my telemedicine patient, my phone rings. My call center informs me that Patient A is continuously calling and screaming profanities because her medications are not ready at her pharmacy. I put the telemedicine patient on hold again to resend the prescriptions.

By now, my telemedicine patient is rightfully frustrated. I apologize. He sees my weary look from being pulled in all directions. He sees how the color has drained from my face. He understands.

We wrap things up and I slouch in my chair. I check my watch and realize that six hours have elapsed; the coffee I brewed hours earlier remains untouched. With no time to eat, drink or use the restroom, I push myself to continue.

Rush, rush, rush. Go, go, go.

Left behind

Patient C: A 46-year-old healthy male, seen over telemedicine for an ER follow-up for a cough. The ER physician attempted to admit the patient for a COVID-19 rule-out but was blocked by the admitting physician, who blatantly called the ER physician an idiot and informed the patient that he was being discharged without further testing.

The patient is confused and is turning to me for solace and answers. He tearfully recounts his experience, during which the nurses were too afraid to touch him, forcing him to remove his own IV upon discharge. I empathize with the patient regarding his deeply unpleasant experience, but I must tell him that unfortunately, he was discharged prematurely, and he will need to return to the same hospital. He is distraught, but he agrees to do so.

After ending the visit, I call the ER. After long moments on hold, I give a report to the charge nurse. Click.

Aftermath

Done with patients for the day, I slow down enough to breathe, reflect and take a sip of cold coffee. During the pandemic, I have started each day with a positive outlook, only for it to end in shambles. My staff is overworked, and layoffs have begun. There are glimpses of hope, but these are far and few in between.

My drive home is quiet. Desolate. More people running red lights. I use the drive to decompress before entering my home, shedding the day’s battle. I eat. I spend hours charting and before I can spend quality time with my family, my phone notifies me it’s time for bed. Sleep is limited, interrupted by nightmares and problems that I cannot solve.

Epilogue

It has been nearly five years since I last read the essay above, which I wrote in 2020. So much has changed in that short span of time, and the pandemic has etched its mark into our everyday lives. While we no longer fear for our lives or wear masks everywhere we venture, as a society, we have changed.

Patients have become increasingly interested in their health, which, while satisfying, has posed a major strain on the medical community. Resources are scarce, and patients are waiting extended amounts of time to get basic care. Patients wait six weeks to see me and up to three months to see my PCP colleagues. Until I left my primary care job in 2024, I continued to spend more time on charting—trying to capture CPT/CPT 2 codes and HCC—rather than providing patient care.

As I mentioned, I left my primary care job in June 2024. Burnout drove me to transition to urgent care. For me, it turned out to be the best decision ever. I have had the energy and time to do things I love that I hadn’t done in ages: sports, enjoying the great outdoors/nature, off-roading and drone photography. Having finally found work-life balance, I also started precepting family medicine residents at my old residency program.

I am finally at peace: My body, mind and spirit are working in harmony.

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