Old Strategies for a New Enemy

My big learning in this pandemic is that we need to use what we already know from years of managing respiratory diseases, rather than treat it like something very new.

We know that most viral infections get better with just supportive treatment.

We know that many doctors over investigate and over treat viral respiratory infections, including blood tests, X-rays, antibiotics, oral bronchodilators, alpha-agonists, and what not..

We know that many patients self-medicate, self-investigate, follow random advice from relatives and friends, and have many cultural taboos.

All of the above has just gotten much much more pronounced due to fear on all fronts..

At the same time, I know lots of doctors who are keeping the flame of rational empathetic medicine alive..

In my practice, only two things are new:

One, educate patients to keep checking SpO2 and keep reporting to me, so that we can detect mild drop in SpO2 before dyspnea starts. And two, somewhat more liberal use of inhaled steroids and oral steroids than before.

The rest is the same..

The rapport-building, with The Golden Minute, open-ended questions, relaxed consultation, respect to the patient’s beliefs and culture, appropriate humour, etc..

The detailed history taking to understand the unique symptoms of each patient, so that we can prescribe personalised symptomatic treatment, and to catch outliers who may not have COVID but some other respiratory illness, or some other concomitant illness like UTI..

For patients with chronic illness, documenting their illnesses and current medications, so that we can suggest appropriate monitoring, and medication change (and use this urgent care episode to encourage better care of their chronic illness)

The examination of neck nodes and sinus tenderness, with the help of patients themselves, in selected patients with symptoms suggesting tonsillitis (painful swallowing) or sinusitis (severe pain in face)..

The mental exercise of reaching a diagnosis or a list of differentials, and deciding a plan of action, including where to treat (home or hospital), what to give (home remedies and symptomatic treatment mostly, with vitamins of choice, steroids appropriately, antibiotics appropriately, etc), what Investigations to order, and when to follow up..

The discussion with the patient and family.. including voicing the diagnosis (with the level of certainty associated with the diagnosis), the prognosis, the treatment options and suggested treatment plan (including explanation of why minimal treatment), and being open to modifying the plan to include their suggestions and cultural beliefs. And most importantly, telling them the red flags, and offering them a way to report back to us.

As rational doctors, let’s keep using all these potent weapons in our arsenal – that’s what will win this battle – until our scientists are able to find an effective treatment, or a vaccine that protects against mutant strains, preferably both!

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