We asked Dr. Karen Hovav from our Medical Advisory Board to share her personal experience as a pediatrician in private practice during the COVID pandemic. Here’s her reflection:
When I walk into the office these days, I’m often struck by the quiet. It’s a weird time to be working as a pediatrician (although honestly, it’s really just a weird time to be a human). It’s a stark contrast to February and March, when the COVID pandemic was unfolding and there was an increasingly frenetic feeling in the air. At that point I was fielding countless calls from anxious parents and strategizing about how to adapt our practice to an emerging epidemic filled with unknowns. In my family life, things were equally chaotic then. Balancing motherhood with work became infinitely more challenging when I no longer had my parents to help with childcare. I felt like I was trying to piece together an impossible puzzle with missing parts.
We’re lucky that our office is spacious and new, with completely separate well and not-so-well entrances and hallways; it’s set up especially well to physically distance. But like many practices, we had to swiftly change how we do visits. Most are now done via telemedicine. We’ve continued to see children under two for their well visits and older children for annual checkups where essential vaccines are given, but otherwise we screen everyone via phone to see what can be assessed without requiring an office visit.
Whereas before COVID my days were spent evaluating fevers, ear pain, colds and the occasional injury, nowadays I’m much more likely to be discussing mental health and emotional concerns, or injuries (one afternoon, I had three children in one hour who needed stitches on the face from falls… kids are literally climbing the walls!). And I find that while I have fewer patients in volume, all encounters have an extra layer of discussion and complexity. Could this be COVID? If it is, what would that mean? How can we know? Should we test or hold off?
Sometimes I’m amazed by how effective telemedicine is. It feels like a whole new world in which parents and I work together to creatively come up with ways for me to get the information I need during an exam (“Can you stretch the skin like this so I can see if the rash disappears? Great, it’s a blanching rash.” “Can you push on this part of the ear so I can see how he responds? Okay, that’s what we typically see in swimmer’s ear.”) I do hope that once this pandemic is past us, we can use the lessons we’ve gained to help make telemedicine more mainstream. It’s a wonderful tool to help us provide care in certain cases.
Still, there’s something about in-person contact that’s irreplaceable. I miss the exuberance and energy of little people, the thoughtful reflections of teenagers, the expressions of warmth on parent’s faces. And nothing beats a thorough physical exam, especially for babies. Just this week, I picked up a hip abnormality in an infant which requires immediate treatment, and torticollis in another little babe (neck tightness which responds to stretching exercises much better when initiated early). It’s reinforced for me how important it is to continue to provide in-person care when appropriate.
As for kids and COVID, we have generally advised parents of children with fever/cough or other COVID-like symptoms to stay home and presume they have it even without testing (this is now changing with the ability of local drive-through test sites). In some cases, we can assume they had it due to a parent or other close contact who was COVID+. Our experience with those children mirrors what the research tells us: most kids have mild symptoms, need supportive care only, and recover within 1-2 weeks. Despite the occasional rare cases, kids seem to be mercifully spared from this virus’s more severe effects.
Parents are incredibly kind and apologetic when they call our office with non-COVID related concerns these day. What they don’t realize is that (a) it’s slower than ever, since everyone at home means fewer kids are sick, and (b) non-COVID stuff matters!! I’d much rather have parents call with their concerns and check in with me. There are reports coming out that one of the fallouts from this phase will be non-COVID medical issues that are unaddressed, leading to bigger problems. Kids with appendicitis are presenting later than usual and often requiring more prolonged and complex treatment because of it. Trust me, I want you to call.
On the days in which I round in the hospital and take care of newborn babies, I know that I need to factor in extra time with parents, to be a cheerleader for moms who need it more than ever. (Until recently, our hospital was restricting visitors, including partners; now partners are allowed but no one else.) Even women who tell me that they spent their last month of pregnancy anxious and worried about how they could possibly do this on their own tell me that they felt so supported by the staff at our hospital (thankfully we have amazing nurses who have truly stepped up and worked to fill the gap as much as humanly possible).
On a personal level, I’m finding practicing in a time of evolving knowledge fascinating. I spend nearly every spare moment reading up on the latest COVID research, connecting with other pediatricians across the country to compare notes on what we’re seeing, and joining online groups with physicians from around the world to learn from their experiences. (I’ve learned to qualify many of my statements to parents with “based on what we know now…”) This time has opened up an amazing community of colleagues from whom I hope to continue to learn long after this pandemic is behind us. And yes, we will get there!
The other day my kids watched that Daniel Tiger episode with the song that goes “Sometimes you have two feelings at the same time, and that’s OK.” Those lyrics sum up my feelings these days quite nicely. I’m grateful and stressed. Concerned yet hopeful. I know that there’s still a long road ahead of us but I also know we’ll get to the other side.