Notes from the Front Line: Family Medicine Adapts

Written by Megan Malgeri, M.D.’12

Coronavirus has certainly changed the way that I practice medicine. I work in family medicine, at a clinic that is the teaching site for family medicine residents. We are one of the busiest primary care clinics in Vermont – learners, preceptors administrators, providers and patients are always moving through our doors. Once the COVID-19 pandemic reached Vermont, this process of providing care and teaching needed to change, and rapidly. Plans, schedules and protocols shifted on a daily, sometimes hourly, basis.  Payment models changed. The hospital drastically modified their operations on a regional scale.  Our department adapted to the new protocols, including setting up an elaborate call system with a mix of providers in different areas. The system is four providers deep in case of provider quarantine or deployment to different roles in health care.  We set up an acute respiratory clinic to serve those who need face-to-face encounters in primary care, and otherwise transitioned our clinic to virtually all telemedicine.

Whereas I used to walk from room to room to see patients in person, I now “zoom” through my day, with video appointments and telephone conversations.  This sounds more action-oriented than it ends up being!  Surprisingly, I can generally care for my patients very well, without seeing them.  Although video or telephone works for most appointments, certain types of problems are challenging to perform without seeing patients: rashes or wound management, elderly patients without video capabilities, children and adults with upper-respiratory or respiratory concerns.  We want to maintain high quality patient care while ensuring public health and safety by keeping people home whenever possible. It has been incredible to see how my colleagues and our leadership rallied together to drastically change the way that we practice medicine. Big changes can happen, even in very large organizations, in a rapid fashion.

My husband and I are both essential workers, so we knew we would continue working as the pandemic loomed.  The anticipation of school and daycare closing was particularly overwhelming.  We are fortunate to both have parents in the area, and we rely on them for childcare when we are both on call, working late, or for early-release days.  However, as older adults are among the most vulnerable groups in this pandemic, we knew it was not responsible to expose our parents to our children, which was both sad and overwhelming for all parties involved.  We found a great duo of sisters to provide tag-team care for our children.  Our school district helped to provide care or financial assistance to families with two essential workers, which alleviated a lot of stress.  Then there was how to proceed with supporting our childcare center, which could no longer provide in-person care, but which would go out of business without parental contributions. We weighed financial, ethical, practical and health considerations as we modified how our family operated.  I have been impressed at how resilient our children have been through this crisis —they barely seemed to skip a beat, despite drastic changes in their day-to-day lives. 

Though I am sure this is a universal sentiment, we worry about how to keep our family safe, especially given that we cannot work exclusively from home.  It’s difficult to grasp the threat in full, so I find we frequently dip our toes into hope, then fear, then back again. One moment I negotiate with my daughter to wash her hands or put away her dinner dishes, and the next minute I contemplate who would care for our very busy young children if we both were to become ill.  I feel generally well and up-beat by day, but have trouble sleeping at night.  This is when I can tell that I am juggling many changes simultaneously.  Overall, I am incredibly grateful for a healthy, vibrant family.  I am grateful for more family time than usual, even if some of that time includes a blurring of the work-life balance and boundaries.  I am impressed at the collective spirit and responsibility that Vermonters are showing by following physical distancing guidelines and adapting to the drastic changes to our day-to-day activities to help flatten the curve and protect the most vulnerable in our community. This is tough, and it will continue to be tough. We all feel our interdependence in how lonely it has been to not see friends and family face-to-face.  I think we will eventually emerge from this with a profound appreciation for our community and all that it has to offer, and with an enhanced safety net for those in greatest need.